Organization
MIND HAVEN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHONTA WILLIAMS MA (MENTAL HEALTH COUNSELOR)
(843) 364-4374
Entity
Organization
Contact information
Practice address
1561 BRAMLETT HILL LN, LAWRENCEVILLE, GA 30045-2601
(843) 364-4374
Mailing address
1561 BRAMLETT HILL LN, LAWRENCEVILLE, GA 30045-2601
(843) 364-4374
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
251B00000X
Case Management Agency
—
—
251K00000X
Public Health or Welfare Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
385HR2055X
Child Mental Illness Respite Care
—
—
Other
Enumeration date
10/18/2022
Last updated
10/18/2022
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