Provider Demographics
NPI:1114664935
Name:SAFE HAVEN MENTAL HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:SAFE HAVEN MENTAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:L
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CSAC
Authorized Official - Phone:757-305-5096
Mailing Address - Street 1:4457 LEAMORE SQUARE RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-4652
Mailing Address - Country:US
Mailing Address - Phone:757-305-5096
Mailing Address - Fax:
Practice Address - Street 1:4457 LEAMORE SQUARE RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-4652
Practice Address - Country:US
Practice Address - Phone:757-305-5096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-13
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health