Healthcare Provider Details

I. General information

NPI: 1134498264
Provider Name (Legal Business Name): DIVINE TOUCH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2011
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1828 ARCH STONE AVE
NORTH LAS VEGAS NV
89031-5095
US

IV. Provider business mailing address

1828 ARCH STONE AVE
NORTH LAS VEGAS NV
89031-5095
US

V. Phone/Fax

Practice location:
  • Phone: 702-787-2116
  • Fax:
Mailing address:
  • Phone: 702-787-2116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MS. SHINEKA C FOY
Title or Position: CEO & PRESIDENT
Credential:
Phone: 702-787-2116