Provider Demographics
NPI:1649540279
Name:HAVENS, CRISANN SUE (BA)
Entity type:Individual
Prefix:MRS
First Name:CRISANN
Middle Name:SUE
Last Name:HAVENS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MRS
Other - First Name:CRISANN
Other - Middle Name:SUE
Other - Last Name:WOODALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:1040 W BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-5516
Mailing Address - Country:US
Mailing Address - Phone:810-257-3724
Mailing Address - Fax:810-257-3795
Practice Address - Street 1:1040 W BRISTOL RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-5516
Practice Address - Country:US
Practice Address - Phone:810-257-3724
Practice Address - Fax:810-257-3795
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker