| Healing Haven Licensed Clinical | |
|
315 E Esplanade Ave Unit 89 San Jacinto CA 92583-5102 | |
| (951) 214-5071 | |
| Not Available |
| Full Name | Healing Haven Licensed Clinical |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 315 E Esplanade Ave Unit 89, San Jacinto, California |
| Authorized Official Name and Position | Kenyada M Wagoner (OWNER/CEO) |
| Authorized Official Contact | 9512145071 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Healing Haven Licensed Clinical 315 E Esplanade Ave Unit 89 San Jacinto CA 92583-5102 Ph: (951) 214-5071 | Healing Haven Licensed Clinical 315 E Esplanade Ave Unit 89 San Jacinto CA 92583-5102 Ph: (951) 214-5071 |
| NPI Number | 1144046608 |
|---|---|
| Provider Enumeration Date | 12/02/2024 |
| Last Update Date | 03/20/2025 |
| Certification Date | 03/20/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144046608 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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