Healthcare Provider Details

I. General information

NPI: 1023974029
Provider Name (Legal Business Name): SAFE HAVEN TELEHEALTH COUNSELING LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2026
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 FREELAND WAY
MONCKS CORNER SC
29461-8868
US

IV. Provider business mailing address

6650 RIVERS AVE STE 105
N CHARLESTON SC
29406-4829
US

V. Phone/Fax

Practice location:
  • Phone: 757-372-1731
  • Fax:
Mailing address:
  • Phone: 843-253-7802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: BRENTLEY SUE ELMORE
Title or Position: OWNER
Credential: LPCA, NCC, ADC-IP
Phone: 757-372-1731