Healthcare Provider Details

I. General information

NPI: 1174230270
Provider Name (Legal Business Name): DIVERGE COMMUNITY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30386 W HURON RIVER DR
FLAT ROCK MI
48134-9714
US

IV. Provider business mailing address

30386 W HURON RIVER DR
FLAT ROCK MI
48134-9714
US

V. Phone/Fax

Practice location:
  • Phone: 734-999-0209
  • Fax: 844-440-2397
Mailing address:
  • Phone: 734-999-0209
  • Fax: 844-440-2397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE OLSZEWSKI
Title or Position: CO-FOUNDER AND THERAPIST
Credential: OTRL
Phone: 734-999-0209