| Safe Haven Llc | |
|
3575 Macon Rd Ste 7 Columbus GA 31907-8227 | |
| (203) 414-9306 | |
| Not Available |
| Full Name | Safe Haven Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 3575 Macon Rd Ste 7, Columbus, Georgia |
| Authorized Official Name and Position | Trevor Johnson (MANGER) |
| Authorized Official Contact | 2034149306 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Safe Haven Llc 4200 Westfield Dr Columbus GA 31907-1838 Ph: (203) 414-9306 | Safe Haven Llc 3575 Macon Rd Ste 7 Columbus GA 31907-8227 Ph: (203) 414-9306 |
| NPI Number | 1932680352 |
|---|---|
| Provider Enumeration Date | 08/23/2018 |
| Last Update Date | 08/23/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932680352 | NPI | - | NPPES |
| 003190107A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | CSW005312 (Georgia) | Primary |
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