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General NPI Number Information
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NPI Number | 1417742883
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Entity Type | Organization
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Legal Business Name | MIND HAVEN PSYCHIATRY PLLC
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Dates
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Enumeration Date | 04/14/2025
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 1515 MOCKINGBIRD LN STE 360
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City | CHARLOTTE
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State | NC
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Zip | 28209-1172
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Country | US
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Telephone | 704-709-5515
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Fax |
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Provider Business Mailing Address
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Address Line | 4728 AUDREY DR
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City | WINSTON SALEM
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State | NC
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Zip | 27127-6698
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Country | US
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Telephone | 828-318-4551
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Fax |
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Authorized Official
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Title or Position | NP/PMHNP
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Name | JASMINE MCENTYRE
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Credential | DNP,FNP-BC,PMHNP-BC
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Telephone | 828-318-4551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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