| Doctor Name: | MR. ROBERT W. DEHAVEN |
| NPI Number: | 1023079555 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.S., NCC, LPC, DAPA |
| License Number: | LPC003880 |
| Business Practice Address: | 121 Ray Rd Hazlehurst, GA - 315395119 |
| Business Phone Number: | 4782969394 |
| Business Fax Number: | 4782969394 |
| Mailing Address: | 121 Ray Rd, HAZLEHURST |
| State: | GA |
| Postal Code: | 315395119 |
| Phone Number: | 4782969394 |
| Fax Number: | 4782969394 |
| NPI Enumeration Date: | 04/02/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | LPC003880 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |