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General NPI Number Information
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NPI Number | 1578807400
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Entity Type | Organization
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Legal Business Name | SAFE HARBOR HAVEN INC.
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 11/15/2012
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Provider Practice Location Address
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Address Line | 4772 SAFE HARBOR WAY
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City | JACKSONVILLE
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State | FL
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Zip | 32226-4024
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Country | US
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Telephone | 904-757-7918
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Fax | 904-757-2504
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Provider Business Mailing Address
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Address Line | 4772 SAFE HARBOR WAY
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City | JACKSONVILLE
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State | FL
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Zip | 32226-4024
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Country | US
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Telephone | 904-757-7918
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Fax | 904-757-2504
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MRS. ROBBIE SMITH
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Credential | LMHC
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Telephone | 904-757-7918
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH5256
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License Number State | FL
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