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Organization
HEALING HAVEN LICENSED CLINICAL
Active
Organization
HEALING HAVEN LICENSED CLINICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENYADA M WAGONER LCSW (OWNER/CEO)
(951) 214-5071
Entity
Organization
Contact information
Practice address
315 E ESPLANADE AVE UNIT 89, SAN JACINTO, CA 92583-5102
(951) 214-5071
Mailing address
315 E ESPLANADE AVE UNIT 89, SAN JACINTO, CA 92583-5102
(951) 214-5071
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
12/02/2024
Last updated
03/20/2025
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