Healthcare Provider Details

I. General information

NPI: 1346281904
Provider Name (Legal Business Name): JOAN ELLEN HAVENS M.A., LPC, PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 SAINT ANDREWS RD
COLUMBIA SC
29210-5816
US

IV. Provider business mailing address

900 SAINT ANDREWS RD
COLUMBIA SC
29210-5816
US

V. Phone/Fax

Practice location:
  • Phone: 803-731-4708
  • Fax: 803-798-7607
Mailing address:
  • Phone: 803-731-4708
  • Fax: 803-798-7607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4909
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: