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General NPI Number Information
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NPI Number | 1063607653
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Entity Type | Organization
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Legal Business Name | HAVEN OF SAFETY, INC.
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Dates
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Enumeration Date | 09/07/2007
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Last Update Date | 09/07/2007
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Provider Practice Location Address
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Address Line | 4150 SNAPFINGER WOODS DR SUITE 208
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City | DECATUR
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State | GA
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Zip | 30035-3417
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Country | US
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Telephone | 404-534-6720
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Fax | 404-534-6722
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Provider Business Mailing Address
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Address Line | 4379 LUXEMBOURG DR
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City | DECATUR
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State | GA
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Zip | 30034-5428
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Country | US
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Telephone | 404-534-6720
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Fax | 404-534-6722
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. WINIFRED GAYLE-BROWN
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Credential |
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Telephone | 404-534-6720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 044645D
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License Number State | GA
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