Provider Demographics
NPI:1851179568
Name:HERITAGE HAVEN
Entity Type:Organization
Organization Name:HERITAGE HAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSWA
Authorized Official - Phone:919-344-2824
Mailing Address - Street 1:2901 SPRINGSWEET LN APT 33
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-7163
Mailing Address - Country:US
Mailing Address - Phone:919-344-2824
Mailing Address - Fax:
Practice Address - Street 1:1710 EAST FRANKLIN STREET
Practice Address - Street 2:#1216
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514
Practice Address - Country:US
Practice Address - Phone:919-344-2824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty