| Blk Haven Corp. | |
|
1633 Karsyn Ln Lithia Springs GA 30122-3970 | |
| (619) 330-5601 | |
| Not Available |
| Full Name | Blk Haven Corp. |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 1633 Karsyn Ln, Lithia Springs, Georgia |
| Authorized Official Name and Position | Ashlee S Wilson (CEO) |
| Authorized Official Contact | 7632450390 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blk Haven Corp. 4047 Noonan St Honolulu HI 96818-6242 Ph: (763) 245-0390 | Blk Haven Corp. 1633 Karsyn Ln Lithia Springs GA 30122-3970 Ph: (619) 330-5601 |
| NPI Number | 1184322455 |
|---|---|
| Provider Enumeration Date | 02/16/2023 |
| Last Update Date | 02/16/2023 |
| Certification Date | 02/16/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184322455 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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