Healthcare Provider Details

I. General information

NPI: 1790381184
Provider Name (Legal Business Name): MARISSA BATIE-COLLIER DIVINE HEALTHCARE CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2020
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 E PARK AVE UNIT 2-J
TALLAHASSEE FL
32301-3446
US

IV. Provider business mailing address

3821 CASTLEBERRY DR
TALLAHASSEE FL
32303-2113
US

V. Phone/Fax

Practice location:
  • Phone: 850-405-3639
  • Fax:
Mailing address:
  • Phone: 850-688-4426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARISSA BATIE-COLLIER
Title or Position: ADMINISTRATOR
Credential: MSW
Phone: 850-688-4426