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General NPI Number Information
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NPI Number | 1588278196
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Entity Type | Organization
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Legal Business Name | HAVEN FOR HEALING, WELLNESS AND RESTORATION, LLC
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Dates
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Enumeration Date | 09/01/2020
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Last Update Date | 09/11/2023
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Provider Practice Location Address
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Address Line | 267 JOHN KNOX RD STE 202
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City | TALLAHASSEE
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State | FL
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Zip | 32303-6692
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Country | US
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Telephone | 803-800-4011
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Fax |
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Provider Business Mailing Address
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Address Line | 2892 E PARK AVE STE 2A
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City | TALLAHASSEE
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State | FL
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Zip | 32301-3447
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Country | US
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Telephone | 803-800-4011
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | BRITTANY PAYNE BRUCE
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Credential | LMHC
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Telephone | 803-800-4011
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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 |
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License Number State |
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