MEDICARE: DIVINE GRIND WELLNESS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1598657884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE GRIND WELLNESS, LLC

Provider Business Mailing Address
First Line	:	1514 HOLLYWOOD AVE
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-1608
Country	:	US
Telephone Number	:	470-768-1610
Fax Number	:

Provider Business Practice Location Address
First Line	:	1514 HOLLYWOOD AVE
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-1608
Country	:	US
Telephone Number	:	470-768-1610
Fax Number	:

Authorized Official
Title or Position	:	DIRECT OWNER
Name	:	STACEY HUFF
Credential	:	LPC
Telephone Number	:	706-499-3250

Provider Enumeration Date	:	07/19/2025
Last Update Date	:	07/24/2025

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