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General NPI Number Information
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NPI Number | 1053823930
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Entity Type | Organization
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Legal Business Name | HAVEN COUNSELING AND WELLNESS
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Dates
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Enumeration Date | 10/31/2017
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Last Update Date | 10/31/2017
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Provider Practice Location Address
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Address Line | 2609 SW 33RD ST # 101-1
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City | OCALA
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State | FL
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Zip | 34471-7774
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Country | US
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Telephone | 352-519-6991
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Fax |
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Provider Business Mailing Address
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Address Line | 2609 SW 33RD ST 101-1
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City | OCALA
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State | FL
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Zip | 34471
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Country | US
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Telephone | 352-519-6991
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NICOLETTE IMMEDIATO
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Credential |
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Telephone | 352-519-6991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | MH15408
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License Number State |
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