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NPI Code Detail

MEDICARE: HAVEN CONNECTION

MEDICARE: HAVEN CONNECTION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1174403976
Entity Type Code : Organization
Provider Name (Legal Business Name) : HAVEN CONNECTION
Provider Business Mailing Address
First Line : 4030 WAKE FOREST RD STE 349
Second Line :
City : RALEIGH
State : NC
Zip : 27609-0010
Country : US
Telephone Number : 252-371-2510
Fax Number :
Provider Business Practice Location Address
First Line : 4030 WAKE FOREST RD STE 349
Second Line :
City : RALEIGH
State : NC
Zip : 27609-0010
Country : US
Telephone Number : 252-371-2510
Fax Number :
Authorized Official
Title or Position : OWNER
Name : KALISTA INCH
Credential : M.S.,LCMHCA,NCC
Telephone Number : 570-850-0042
Provider Enumeration Date : 09/03/2025
Last Update Date : 03/03/2026

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Directions to “HAVEN CONNECTION ” Practice Location

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