# MIND HAVEN LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427774629
- **Authorized official:** SHONTA WILLIAMS MA (MENTAL HEALTH COUNSELOR)
- **Authorized official phone:** (843) 364-4374

## Contact information

- **Practice address:** 1561 BRAMLETT HILL LN, LAWRENCEVILLE, GA 30045-2601
- **Practice address phone:** (843) 364-4374
- **Mailing address:** 1561 BRAMLETT HILL LN, LAWRENCEVILLE, GA 30045-2601
- **Mailing address phone:** (843) 364-4374

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 251B00000X | Case Management Agency | — | NULL | — |
| 251K00000X | Public Health or Welfare Agency | — | NULL | Yes |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | — |
| 385HR2055X | Child Mental Illness Respite Care | — | NULL | — |

## Other

- **Enumeration date:** 10/18/2022
- **Last updated:** 10/18/2022