Provider Demographics
NPI:1346950557
Name:DOVE HEALING CENTER LLC
Entity Type:Organization
Organization Name:DOVE HEALING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:LATEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:502-771-2651
Mailing Address - Street 1:1830 DESTINY LN STE 112
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-1089
Mailing Address - Country:US
Mailing Address - Phone:502-771-2651
Mailing Address - Fax:270-303-9001
Practice Address - Street 1:1830 DESTINY LN STE 112
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-1089
Practice Address - Country:US
Practice Address - Phone:502-771-2651
Practice Address - Fax:270-303-9001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty