Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 102L00000X | Psychologist | 24211 | CA |
Y | 103T00000X | Psychologist | 24211 | CA |
NPI | 1003033309 |
---|---|
Provider Name | Ms. Debbra Melody Haven |
First Address | Arcata, CA 95521-6249 |
Second Address | Eureka, CA 95501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 28/08/2019 |