NPIMap

Organization Active NPI

Haven Ministries, Inc.

  • Child & Adolescent Psychiatry Physician
  • Lake Waccamaw, NC
National Provider Identifier
1306171244
Registry record updated Oct 9, 2009
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.
Practice address
400 Flemington Drive
Lake Waccamaw, NC 28450-2512
Phone
(910) 803-1620
Fax
(484) 315-2387
NPI assigned
Oct 9, 2009
Last updated
Oct 9, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2009

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

Authorized official

Name
Dr. Dwight Lysne, M.D., M.DIV.
Title
Director
Phone
(910) 803-1620

Specialties & licenses 1

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

Addresses

Primary practice location

400 Flemington Drive
Lake Waccamaw, NC 28450-2512

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

Other organizations with this tax ID 7

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

Locations

400 Flemington Dr
Lake Waccamaw, NC 28450
Phone (910) 646-3083

NPI Registry JSON

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

{
    "created_epoch": "1255046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255046400000",
    "number": "1306171244",
    "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": "484-315-2387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 FLEMINGTON DRIVE",
            "city": "LAKE WACCAMAW",
            "state": "NC",
            "postal_code": "284502512",
            "telephone_number": "910-803-1620",
            "fax_number": "484-315-2387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAVEN MINISTRIES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-09",
        "last_updated": "2009-10-09",
        "status": "A",
        "authorized_official_last_name": "LYSNE",
        "authorized_official_first_name": "DWIGHT",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "910-803-1620",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D., M.DIV."
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NC",
            "license": "200301378",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Waccamaw, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2009; 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.