Provider Demographics
NPI:1336599257
Name:MICHELE'S HAVEN, CDC, INC.
Entity Type:Organization
Organization Name:MICHELE'S HAVEN, CDC, INC.
Other - Org Name:MICHELE'S HAVEN, CDC, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:GILMER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:443-858-1002
Mailing Address - Street 1:1270 BEAUMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-3418
Mailing Address - Country:US
Mailing Address - Phone:443-858-1002
Mailing Address - Fax:
Practice Address - Street 1:1270 BEAUMONT AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-3418
Practice Address - Country:US
Practice Address - Phone:443-858-1002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty