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General NPI Number Information
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NPI Number | 1972060804
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Entity Type | Organization
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Legal Business Name | HAVEN WELLNESS CENTERS LLC
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Dates
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Enumeration Date | 02/27/2019
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Last Update Date | 02/27/2019
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Provider Practice Location Address
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Address Line | 919 ORANGE AVE STE 200
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City | WINTER PARK
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State | FL
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Zip | 32789-4764
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Country | US
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Telephone | 305-492-5909
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Fax |
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Provider Business Mailing Address
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Address Line | 919 ORANGE AVE STE 200
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City | WINTER PARK
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State | FL
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Zip | 32789-4764
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Country | US
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Telephone | 305-492-5909
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Fax |
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Authorized Official
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Title or Position | SOLE MBR
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Name | LIZNEY SIEVERT
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Credential |
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Telephone | 305-492-5909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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