Provider Demographics
NPI:1932340288
Name:HAVEN OF HOPE OF DEKALB COUNTY, INC.
Entity Type:Organization
Organization Name:HAVEN OF HOPE OF DEKALB COUNTY, INC.
Other - Org Name:HAVEN OF HOPE COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CENTER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINTERO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, SLPE
Authorized Official - Phone:615-597-4673
Mailing Address - Street 1:612 S CONGRESS BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:SMITHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37166-2009
Mailing Address - Country:US
Mailing Address - Phone:615-597-4673
Mailing Address - Fax:615-597-4673
Practice Address - Street 1:612 S CONGRESS BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:SMITHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37166-2009
Practice Address - Country:US
Practice Address - Phone:615-597-4673
Practice Address - Fax:615-597-4673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000000703101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty