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General NPI Number Information
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NPI Number | 1801601737
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Entity Type | Organization
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Legal Business Name | THE HEALING HAVEN LLC
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Dates
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Enumeration Date | 02/10/2025
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 3908 BREEZEPORT WAY APT 206
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City | SUFFOLK
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State | VA
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Zip | 23435-1086
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Country | US
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Telephone | 757-537-9379
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 SHIPYARD RD STE D
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City | CHESAPEAKE
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State | VA
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Zip | 23323-5517
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Country | US
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Telephone | 757-537-9379
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | MARISSA BROWN
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Credential | LCSW
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Telephone | 757-537-9379
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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