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General NPI Number Information
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NPI Number | 1710343645
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Entity Type | Organization
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Legal Business Name | SAFEHAVEN COUNSELING SERVICES,LLC
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Dates
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Enumeration Date | 01/07/2016
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Last Update Date | 01/07/2016
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Provider Practice Location Address
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Address Line | 2792 US HIGHWAY 80 W
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City | DUBLIN
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State | GA
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Zip | 31021-0907
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Country | US
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Telephone | 478-278-3328
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Fax |
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Provider Business Mailing Address
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Address Line | 4004 TURKEY CREEK RD
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City | DANVILLE
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State | GA
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Zip | 31017-2021
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Country | US
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Telephone | 478-962-0456
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SANDRA DIANNE GILMORE
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Credential | LPC/RN
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Telephone | 478-278-3328
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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