Provider Demographics
NPI:1316183163
Name:HAVENS, LISA MARGARET (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARGARET
Last Name:HAVENS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 184
Mailing Address - Street 2:
Mailing Address - City:SUTTONS BAY
Mailing Address - State:MI
Mailing Address - Zip Code:49682-0184
Mailing Address - Country:US
Mailing Address - Phone:231-271-5500
Mailing Address - Fax:231-271-5959
Practice Address - Street 1:93B FOURTH STREET
Practice Address - Street 2:
Practice Address - City:SUTTONS BAY
Practice Address - State:MI
Practice Address - Zip Code:49682-0184
Practice Address - Country:US
Practice Address - Phone:231-271-5500
Practice Address - Fax:231-271-5959
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010846581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical