Healthcare Provider Details

I. General information

NPI: 1801422415
Provider Name (Legal Business Name): DIVERGENT WORLDS PSYCHOTHERAPY AND CONSULTING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2020
Last Update Date: 03/14/2020
Certification Date: 03/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 FULTON ST STE 106
SAN FRANCISCO CA
94102-4364
US

IV. Provider business mailing address

459 FULTON ST STE 106
SAN FRANCISCO CA
94102-4364
US

V. Phone/Fax

Practice location:
  • Phone: 415-625-9778
  • Fax:
Mailing address:
  • Phone: 415-625-9778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. RACHEL A ROBBINS
Title or Position: CEO, OWNER, LICENSED PSYCHOLOGIST
Credential: PSY.D.
Phone: 415-625-9778