NPIMap

Organization Active NPI

Haven Ministries, Inc. @ Agape

  • Child & Adolescent Psychiatry Physician
  • Wilmington, NC
National Provider Identifier
1164735254
Registry record updated Jul 19, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
200301378 Issued in NC
Legal business name
HAVEN MINISTRIES, INC. @ AGAPE
Practice address
3725B Wrightsville Ave
Wilmington, NC 28403-4140
Phone
(910) 803-1620
Fax
(215) 902-4882
NPI assigned
Jul 19, 2010
Last updated
Jul 19, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
HAVEN MINISTRIES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 19, 2010

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

Authorized official

Name
Dr. Dwight Howard Lysne, MD, MDIV
Title
Director
Phone
(910) 803-1620

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry Physician 2084P0804X 200301378 NC Primary

Addresses

Primary practice location

3725B Wrightsville Ave
Wilmington, NC 28403-4140

Mailing address

7212 Oyster LN
Wilmington, NC 28411-7132
Phone (910) 803-1620

National Provider Directory

National Provider Directory
Tax ID family
Haven Ministries Inc Agape8 organizations share this tax ID, including this one
Part of
Haven Ministries Inc Agape

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3725B Wrightsville Ave
Wilmington, NC 28403
Phone (910) 803-1620

NPI Registry JSON

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

{
    "created_epoch": "1279497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279497600000",
    "number": "1164735254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7212 OYSTER LN",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284117132",
            "telephone_number": "910-803-1620",
            "fax_number": "215-902-4882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3725B WRIGHTSVILLE AVE",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284034140",
            "telephone_number": "910-803-1620",
            "fax_number": "215-902-4882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAVEN MINISTRIES, INC. @ AGAPE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HAVEN MINISTRIES, INC.",
        "enumeration_date": "2010-07-19",
        "last_updated": "2010-07-19",
        "status": "A",
        "authorized_official_last_name": "LYSNE",
        "authorized_official_first_name": "DWIGHT",
        "authorized_official_middle_name": "HOWARD",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "910-803-1620",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD, MDIV"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NC",
            "license": "200301378",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2010; 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.