Healthcare Provider Details

I. General information

NPI: 1477431492
Provider Name (Legal Business Name): DIVINE HEALING BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 LAKELAND DR STE 200
FLOWOOD MS
39232-8853
US

IV. Provider business mailing address

2944 RAY WEILAND DR
BAKER LA
70714-3250
US

V. Phone/Fax

Practice location:
  • Phone: 225-993-1535
  • Fax:
Mailing address:
  • Phone: 225-993-1535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHARMAINE STITH
Title or Position: MANAGER
Credential:
Phone: 225-993-1535