Provider Demographics
NPI:1326934795
Name:HOLISTIC HAVEN THERAPY LLC
Entity type:Organization
Organization Name:HOLISTIC HAVEN THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SADIA
Authorized Official - Middle Name:ANJUM
Authorized Official - Last Name:MOHAMMADI
Authorized Official - Suffix:
Authorized Official - Credentials:REVEREND DR, MA, HP
Authorized Official - Phone:863-657-5691
Mailing Address - Street 1:9460 S ORANGE BLOSSOM TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837
Mailing Address - Country:US
Mailing Address - Phone:863-657-5691
Mailing Address - Fax:518-977-7100
Practice Address - Street 1:9460 S ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837
Practice Address - Country:US
Practice Address - Phone:863-657-5691
Practice Address - Fax:518-977-7100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty