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General NPI Number Information
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NPI Number | 1851590558
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Entity Type | Organization
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Legal Business Name | SAFE HAVEN CHILD AND FAMILY COUNSELING SERVICES,LLC
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Dates
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Enumeration Date | 07/12/2007
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Last Update Date | 05/15/2024
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Provider Practice Location Address
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Address Line | 233 S SHARON AMITY RD STE 102
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City | CHARLOTTE
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State | NC
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Zip | 28211-2893
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Country | US
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Telephone | 704-763-9555
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Fax | 704-709-8580
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Provider Business Mailing Address
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Address Line | 233 S SHARON AMITY RD STE 102
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City | CHARLOTTE
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State | NC
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Zip | 28211-2893
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Country | US
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Telephone | 704-763-5555
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Fax | 704-709-8580
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MS. COSSSANDRA EVETTE MILLER
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Credential | LCSW
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Telephone | 704-763-9555
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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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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | C005101
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License Number State | NC
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