=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023974029
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAFE HAVEN TELEHEALTH COUNSELING LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2026
-----------------------------------------------------
Last Update Date | 01/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 303 FREELAND WAY
-----------------------------------------------------
City | MONCKS CORNER
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29461-8868
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-372-1731
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6650 RIVERS AVE STE 105
-----------------------------------------------------
City | N CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29406-4829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-253-7802
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BRENTLEY SUE ELMORE
-----------------------------------------------------
Credential | LPCA, NCC, ADC-IP
-----------------------------------------------------
Telephone | 757-372-1731
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------