Provider Demographics
NPI:1467978874
Name:HAVEN COUNSELING GROUP, PLLC
Entity Type:Organization
Organization Name:HAVEN COUNSELING GROUP, PLLC
Other - Org Name:HAVEN COUNSELING
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:HANNAH
Authorized Official - Last Name:HOUSTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:270-871-8136
Mailing Address - Street 1:904 S COX ST
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-6466
Mailing Address - Country:US
Mailing Address - Phone:270-871-8136
Mailing Address - Fax:336-610-0209
Practice Address - Street 1:904 S COX ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-6466
Practice Address - Country:US
Practice Address - Phone:336-626-0208
Practice Address - Fax:336-610-0209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-17
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13247101YP2500X
261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty