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General NPI Number Information
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NPI Number | 1104779750
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Entity Type | Organization
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Legal Business Name | DIVINE DESIGN PSYCHIATRY AND WELLNESS
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Dates
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Enumeration Date | 02/16/2026
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Last Update Date | 02/16/2026
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Provider Practice Location Address
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Address Line | 853 CHESAPEAKE JUNCTION LN
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City | O FALLON
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State | IL
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Zip | 62269-7035
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Country | US
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Telephone | 217-816-7928
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Fax | 616-208-2675
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Provider Business Mailing Address
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Address Line | 853 CHESAPEAKE JUNCTION LN
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City | O FALLON
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State | IL
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Zip | 62269-7035
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Country | US
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Telephone | 217-816-7928
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Fax | 616-208-2675
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Authorized Official
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Title or Position | NURSE PRACTITIONER/OWNER
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Name | ANGELA SEVERADO
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Credential | FNP/PMHNP
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Telephone | 217-816-7928
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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