Organization
BLK HAVEN CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEE S WILSON LPCC (CEO)
(763) 245-0390
Entity
Organization
Contact information
Practice address
1633 KARSYN LN, LITHIA SPRINGS, GA 30122-3970
(619) 330-5601
Mailing address
4047 NOONAN ST, HONOLULU, HI 96818-6242
(763) 245-0390
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
02/16/2023
Last updated
02/16/2023
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