Provider Demographics
NPI:1922563659
Name:GAINESVILLE HEALING HOUSE, INC.
Entity Type:Organization
Organization Name:GAINESVILLE HEALING HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:NENEZIAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:352-660-4142
Mailing Address - Street 1:1810 NW 6TH ST STE E
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-8535
Mailing Address - Country:US
Mailing Address - Phone:352-660-4142
Mailing Address - Fax:
Practice Address - Street 1:1810 NW 6TH ST STE E
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-8535
Practice Address - Country:US
Practice Address - Phone:352-660-4142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty