Organization
HAVEN DEVELOPMENTAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CAROL AGATHA TRIM-BAGOT MA (DIRECTOR/CEO)
(770) 761-3402
Entity
Organization
Contact information
Practice address
4794 MICHAEL JAY ST, SNELLVILLE, GA 30039-7630
(770) 761-3402
(770) 679-4561
Mailing address
4794 MICHAEL JAY ST, SNELLVILLE, GA 30039-7630
(770) 761-3402
(770) 679-4561
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
CLA000738
GA
Other
Enumeration date
09/28/2011
Last updated
09/28/2011
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