Organization
SAFE HAVEN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TREVOR JOHNSON LCSW (MANGER)
(203) 414-9306
Entity
Organization
Contact information
Practice address
3575 MACON RD STE 7, COLUMBUS, GA 31907-8227
(203) 414-9306
Mailing address
4200 WESTFIELD DR, COLUMBUS, GA 31907-1838
(203) 414-9306
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW005312
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003190107A
—
GA
Enumeration date
08/23/2018
Last updated
08/23/2018
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