Healthcare Provider Details

I. General information

NPI: 1942813597
Provider Name (Legal Business Name): DIVINE INTERVENTIONS BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CANEBRAKE BLVD STE 110-17
FLOWOOD MS
39232-2211
US

IV. Provider business mailing address

PO BOX 821878
VICKSBURG MS
39182-1878
US

V. Phone/Fax

Practice location:
  • Phone: 769-300-1012
  • Fax: 844-444-0779
Mailing address:
  • Phone: 769-203-8141
  • Fax: 844-444-0779

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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CHASITY DAVIS
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 769-300-1012