Provider Demographics
NPI:1588425078
Name:HAVEN AUTISM
Entity type:Organization
Organization Name:HAVEN AUTISM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYON
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-312-9435
Mailing Address - Street 1:125 CLAIREMONT AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2558
Mailing Address - Country:US
Mailing Address - Phone:678-210-7070
Mailing Address - Fax:404-745-0106
Practice Address - Street 1:125 CLAIREMONT AVE STE 205
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2558
Practice Address - Country:US
Practice Address - Phone:678-210-7070
Practice Address - Fax:404-745-0106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health