Provider Demographics
NPI:1417742883
Name:MIND HAVEN PSYCHIATRY PLLC
Entity type:Organization
Organization Name:MIND HAVEN PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP/PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCENTYRE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP,FNP-BC,PMHNP-BC
Authorized Official - Phone:828-318-4551
Mailing Address - Street 1:4728 AUDREY DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-6698
Mailing Address - Country:US
Mailing Address - Phone:828-318-4551
Mailing Address - Fax:
Practice Address - Street 1:1515 MOCKINGBIRD LN STE 360
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-1172
Practice Address - Country:US
Practice Address - Phone:704-709-5515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-14
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty