Provider Demographics
NPI:1003230277
Name:HAVEN HOUSE COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:HAVEN HOUSE COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KHAALIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FORBES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWC
Authorized Official - Phone:404-243-9336
Mailing Address - Street 1:4650 FLAT SHOALS PKWY
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-5000
Mailing Address - Country:US
Mailing Address - Phone:404-243-9336
Mailing Address - Fax:404-212-1265
Practice Address - Street 1:4650 FLAT SHOALS PKWY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-5000
Practice Address - Country:US
Practice Address - Phone:404-243-9336
Practice Address - Fax:404-212-1265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-09
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty