Healthcare Provider Details

I. General information

NPI: 1417742883
Provider Name (Legal Business Name): MIND HAVEN PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1981 STALLINGS RD
STALLINGS NC
28104-1104
US

IV. Provider business mailing address

4728 AUDREY DR
WINSTON SALEM NC
27127-6698
US

V. Phone/Fax

Practice location:
  • Phone: 704-709-5515
  • Fax: 704-709-5537
Mailing address:
  • Phone: 828-318-4551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JASMINE MCENTYRE
Title or Position: NP/PMHNP
Credential: DNP,FNP-BC,PMHNP-BC
Phone: 828-318-4551