Organization Name: | BETHEL HAVEN, INC |
NPI Number: | 1346574134 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DIANE BRANTLEY (EXECUTIVE DIRECTOR) |
Mailing Address: | 1030 Village Dr Ste B Watkinsville |
State: | GA US |
Postal Code: | 306776004 |
Phone Number: | 7063109046 |
Fax Number: | 7063109076 |
NPI Enumeration Date: | 09/25/2009 |
NPI Last Update Date: | 10/10/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |