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Organization
HAVEN OF SAFETY, INC.
Active
Organization
HAVEN OF SAFETY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. WINIFRED GAYLE-BROWN (ADMINISTRATOR)
(404) 534-6720
Entity
Organization
Contact information
Practice address
4150 SNAPFINGER WOODS DR, SUITE 208, DECATUR, GA 30035-3417
(404) 534-6720
(404) 534-6722
Mailing address
4379 LUXEMBOURG DR, DECATUR, GA 30034-5428
(404) 534-6720
(404) 534-6722
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
044645D
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4279383701100
MHDDAD PROVIDER AGREEMENT
GA
Enumeration date
09/07/2007
Last updated
09/07/2007
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