Healthcare Provider Details

I. General information

NPI: 1649951955
Provider Name (Legal Business Name): DIVINE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 07/28/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 PAINTERS MILL RD STE 136
OWINGS MILLS MD
21117-3610
US

IV. Provider business mailing address

1829 REISTERSTOWN RD STE 350
PIKESVILLE MD
21208-7126
US

V. Phone/Fax

Practice location:
  • Phone: 443-955-2662
  • Fax:
Mailing address:
  • Phone: 443-955-2662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: CARA ASHLEY RAQUEL BALTIMORE
Title or Position: CEO
Credential:
Phone: 443-202-1377