Healing Haven Licensed Clinical

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

HEALING HAVEN LICENSED CLINICAL

Practice address

315 E Esplanade Ave Unit 89
San Jacinto, CA 92583-5102

Phone

(951) 214-5071

NPI assigned

Dec 2, 2024

Organization subpart

No

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

Authorized official

Name

Kenyada M Wagoner, LCSWNPI 1760172688

Title

Owner/Ceo

Phone

(951) 214-5071

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Kenyada Marie Wagoner, LCSW

  • Clinical Social Worker
  • Riverside, CA
  • NPI 1760172688
  NPD (past) Authorized official

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

{
    "created_epoch": "1733097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742428800000",
    "number": "1144046608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 E ESPLANADE AVE UNIT 89",
            "city": "SAN JACINTO",
            "state": "CA",
            "postal_code": "925835102",
            "telephone_number": "951-214-5071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 E ESPLANADE AVE UNIT 89",
            "city": "SAN JACINTO",
            "state": "CA",
            "postal_code": "925835102",
            "telephone_number": "951-214-5071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALING HAVEN LICENSED CLINICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-02",
        "last_updated": "2025-03-20",
        "certification_date": "2025-03-20",
        "status": "A",
        "authorized_official_last_name": "WAGONER",
        "authorized_official_first_name": "KENYADA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "951-214-5071",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristian Harris
• Deanna Hart
• Mera Hashwani, PT, DPT
• Lorri Ann Hays
• Jenessa Headley
• Healing Haven Mental Health
• Healthcare Management Systems, Inc
• Healthy Life Nemt LLC
• Jaime L Helton, RN
• Paula Henke

• Clinical Social Worker in San Jacinto, CA
• Providers in San Jacinto, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2025; 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.