Provider Demographics
NPI:1245106889
Name:THE HAVEN SUPPORT SERVICES LLC
Entity type:Organization
Organization Name:THE HAVEN SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTNY
Authorized Official - Middle Name:RAQUEL
Authorized Official - Last Name:KINNEBREW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-266-0756
Mailing Address - Street 1:512 RIVERSIDE PKWY NE STE 701
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-2910
Mailing Address - Country:US
Mailing Address - Phone:706-266-0756
Mailing Address - Fax:706-625-7660
Practice Address - Street 1:512 RIVERSIDE PKWY NE STE 701
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-2910
Practice Address - Country:US
Practice Address - Phone:706-266-0756
Practice Address - Fax:706-625-7660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty