| Haven Intergrative Therapy Center, Llc | |
|
4252 Carmichael Rd Ste 107-108 Montgomery AL 36106-2804 | |
| (334) 356-4960 | |
| (334) 356-4961 |
| Full Name | Haven Intergrative Therapy Center, Llc |
|---|---|
| Speciality | Counselor |
| Location | 4252 Carmichael Rd Ste 107-108, Montgomery, Alabama |
| Authorized Official Name and Position | Carrie J Nelson (MEMBER) |
| Authorized Official Contact | 3343126774 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Haven Intergrative Therapy Center, Llc 4252 Carmichael Rd Ste 107-108 Montgomery AL 36106-2804 Ph: (334) 356-4960 | Haven Intergrative Therapy Center, Llc 4252 Carmichael Rd Ste 107-108 Montgomery AL 36106-2804 Ph: (334) 356-4960 |
| NPI Number | 1730602996 |
|---|---|
| Provider Enumeration Date | 07/19/2017 |
| Last Update Date | 09/24/2020 |
| Certification Date | 09/24/2020 |
| Medicare PECOS PAC ID | 8729336474 |
|---|---|
| Medicare Enrollment ID | O20180813001358 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730602996 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 1646C (Alabama) | Primary |
| Provider Name | Carrie Juanita Nelson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932256328 PECOS PAC ID: 3274881925 Enrollment ID: I20180813003306 |
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