Healthcare Provider Details

I. General information

NPI: 1679491823
Provider Name (Legal Business Name): DIVINE DESIGN PSYCHOTHERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 S KENSINGTON AVE
KANKAKEE IL
60901-8095
US

IV. Provider business mailing address

1735 S KENSINGTON AVE
KANKAKEE IL
60901-8095
US

V. Phone/Fax

Practice location:
  • Phone: 815-545-6701
  • Fax: 510-370-4034
Mailing address:
  • Phone: 815-545-6701
  • Fax: 510-370-4034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ROBYN CARAVELLO
Title or Position: MANAGING MEMBER
Credential: LCPC
Phone: 815-545-6701