Organization
IVY HAVEN COUNSELING AND CONSULTING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHONTA WILLIAMS (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
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
385HR2055X
Child Mental Illness Respite Care
—
—
Other
Enumeration date
07/11/2021
Last updated
07/11/2021
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