Provider Demographics
NPI:1720844137
Name:MIND HAVEN MENTAL HEALTH PLLC
Entity Type:Organization
Organization Name:MIND HAVEN MENTAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJAI
Authorized Official - Middle Name:
Authorized Official - Last Name:DAYAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-508-1254
Mailing Address - Street 1:6812 CREEK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-7028
Mailing Address - Country:US
Mailing Address - Phone:910-508-1254
Mailing Address - Fax:
Practice Address - Street 1:4312 HENSON DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-7424
Practice Address - Country:US
Practice Address - Phone:919-641-1025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty