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General NPI Number Information
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NPI Number | 1598068033
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Entity Type | Organization
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Legal Business Name | NEW LIFE HAVEN MININSTRIES INC.
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Dates
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Enumeration Date | 12/06/2010
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Last Update Date | 12/06/2010
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Provider Practice Location Address
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Address Line | 4919 W COLONIAL DR
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City | ORLANDO
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State | FL
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Zip | 32808-7703
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Country | US
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Telephone | 407-610-5509
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Fax |
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Provider Business Mailing Address
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Address Line | 5027 LIDO ST
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City | ORLANDO
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State | FL
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Zip | 32807-1323
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Country | US
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Telephone | 321-225-0608
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Fax |
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Authorized Official
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Title or Position | PRES.
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Name | MS. GLADYS G STEPHENS
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Credential |
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Telephone | 321-225-0608
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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