Provider Demographics
NPI:1336824978
Name:HAVEN PREGNANCY WELLNESS & WOMEN'S HEALTH, LLC
Entity type:Organization
Organization Name:HAVEN PREGNANCY WELLNESS & WOMEN'S HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH, MHS
Authorized Official - Phone:601-255-8258
Mailing Address - Street 1:665 S PEAR ORCHARD RD STE 106-784
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4861
Mailing Address - Country:US
Mailing Address - Phone:601-255-8258
Mailing Address - Fax:
Practice Address - Street 1:302 HIGHLAND PARK CV STE B
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-6058
Practice Address - Country:US
Practice Address - Phone:601-255-8258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-20
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty