Healthcare Provider Details

I. General information

NPI: 1295578284
Provider Name (Legal Business Name): DEVINE COUNSELING AND WELLNESS ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W HONDO AVE
DEVINE TX
78016-2922
US

IV. Provider business mailing address

203 CARDINAL DR
DEVINE TX
78016-2407
US

V. Phone/Fax

Practice location:
  • Phone: 830-224-0024
  • Fax: 830-224-0030
Mailing address:
  • Phone: 830-224-0024
  • Fax: 830-224-0030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. VONNA SMITH
Title or Position: MANAGER
Credential: LCSW
Phone: 830-224-0024