Provider Demographics
NPI:1538935812
Name:INTEGRATED WELLNESS HAVEN LLC
Entity type:Organization
Organization Name:INTEGRATED WELLNESS HAVEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:THEODORA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEDEJI
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCPC, NCC
Authorized Official - Phone:301-259-5359
Mailing Address - Street 1:1 RESEARCH CT STE 450
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6252
Mailing Address - Country:US
Mailing Address - Phone:301-259-5359
Mailing Address - Fax:301-246-6523
Practice Address - Street 1:1 RESEARCH CT
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3221
Practice Address - Country:US
Practice Address - Phone:301-259-5359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)