Healthcare Provider Details

I. General information

NPI: 1336947415
Provider Name (Legal Business Name): DIVINE REVELATIONS MINISTRIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W PENSACOLA ST FL 3
TALLAHASSEE FL
32301-1618
US

IV. Provider business mailing address

PO BOX 3670
TALLAHASSEE FL
32315-3670
US

V. Phone/Fax

Practice location:
  • Phone: 877-572-3399
  • Fax: 877-572-3399
Mailing address:
  • Phone: 877-572-3399
  • Fax: 877-572-3399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: BERNICE MCMILLAN
Title or Position: CO-FOUNDER/EXECUTIVE DIRECTOR
Credential: MBA, CLC
Phone: 877-572-3399