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General NPI Number Information
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NPI Number | 1245606888
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Entity Type | Organization
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Legal Business Name | SAFE HAVEN COUNSELING LLC
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Dates
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Enumeration Date | 08/18/2015
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Last Update Date | 08/19/2015
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Provider Practice Location Address
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Address Line | 1490 S MILITARY TRL SUITE 7
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City | WEST PALM BEACH
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State | FL
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Zip | 33415-9190
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Country | US
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Telephone | 561-346-7731
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Fax |
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Provider Business Mailing Address
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Address Line | 1490 S MILITARY TRL SUITE 7
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City | WEST PALM BEACH
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State | FL
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Zip | 33415-9190
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Country | US
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Telephone | 561-346-7731
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAN LICHTENBERGER
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Credential |
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Telephone | 561-346-7731
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 10D2100079
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License Number State | FL
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