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General NPI Number Information
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NPI Number | 1124709308
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Entity Type | Organization
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Legal Business Name | WELLNESS HAVEN LLC
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Dates
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Enumeration Date | 07/31/2023
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Last Update Date | 08/08/2023
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Provider Practice Location Address
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Address Line | 7285 LAKESHORE RD
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City | LEXINGTON
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State | MI
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Zip | 48450-9772
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Country | US
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Telephone | 810-300-9465
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Fax |
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Provider Business Mailing Address
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Address Line | 5124 BIRCH AVE
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City | LEXINGTON
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State | MI
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Zip | 48450-9261
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PROFESSIONAL COUNSELOR
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Name | KORTNEY BALL
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Credential | L.P.C., S.C.L.
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Telephone | 810-300-9465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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