Provider Demographics
NPI:1467549113
Name:VON HAVEN, CARLA (LMHC, CAP)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:VON HAVEN
Suffix:
Gender:F
Credentials:LMHC, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4630 SHADESVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-9136
Mailing Address - Country:US
Mailing Address - Phone:850-221-3873
Mailing Address - Fax:
Practice Address - Street 1:435 E ZARAGOZA ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-6154
Practice Address - Country:US
Practice Address - Phone:850-221-9379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3388101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health