Healthcare Provider Details

I. General information

NPI: 1932651718
Provider Name (Legal Business Name): SAFE HAVEN COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4094 MAIN ST STE 202
HILLIARD OH
43026-3429
US

IV. Provider business mailing address

4094 MAIN ST STE 202
HILLIARD OH
43026-3429
US

V. Phone/Fax

Practice location:
  • Phone: 614-777-6373
  • Fax: 614-777-6375
Mailing address:
  • Phone: 614-777-6373
  • Fax: 614-777-6375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberE0600321
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE0600321
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE0600321
License Number StateOH

VIII. Authorized Official

Name: SANDRA LEE DEAS
Title or Position: COUNSELOR/SOLE PROPRIETOR
Credential: MS LPCC
Phone: 614-315-4190