Organization
DAVINA'S HAVEN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIELRAY MOISES BLEA SMITH (OWNER/DIRECTOR)
(505) 906-0002
Entity
Organization
Contact information
Practice address
4405 JAGER DR NE STE C4, RIO RANCHO, NM 87144-5715
(505) 906-0002
Mailing address
4405 JAGER DR NE STE C4, RIO RANCHO, NM 87144-5715
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
12/12/2024
Last updated
02/22/2025
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