NPIMap

Organization Active NPI

Haven House Counseling Center, LLC

  • Clinical Social Worker
  • Decatur, GA
National Provider Identifier
1003230277
Registry record updated Apr 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
HAVEN HOUSE COUNSELING CENTER, LLC
Practice address
4650 Flat Shoals Pkwy
Decatur, GA 30034-5000
Phone
(404) 243-9336
Fax
(404) 212-1265
NPI assigned
Feb 9, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Khaalida Forbes, LCSWC
Title
Executive Director
Phone
(404) 243-9336

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X GA Primary

Addresses

Primary practice location

4650 Flat Shoals Pkwy
Decatur, GA 30034-5000

Mailing address

4650 Flat Shoals Pkwy
Decatur, GA 30034-5000
Phone (404) 243-9336

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1391904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398643200000",
    "number": "1003230277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4650 FLAT SHOALS PKWY",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300345000",
            "telephone_number": "404-243-9336",
            "fax_number": "404-212-1265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4650 FLAT SHOALS PKWY",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300345000",
            "telephone_number": "404-243-9336",
            "fax_number": "404-212-1265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAVEN HOUSE COUNSELING CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-09",
        "last_updated": "2014-04-28",
        "status": "A",
        "authorized_official_last_name": "FORBES",
        "authorized_official_first_name": "KHAALIDA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "404-243-9336",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "LCSWC"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.