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General NPI Number Information
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NPI Number | 1124574991
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Entity Type | Organization
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Legal Business Name | DIVINE COUNSELING AND WELLNESS INC
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Dates
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Enumeration Date | 08/31/2016
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Last Update Date | 11/28/2018
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Provider Practice Location Address
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Address Line | 5020 ROUTE 9W SUITE 104
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City | NEWBURGH
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State | NY
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Zip | 12550-7900
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Country | US
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Telephone | 845-237-2862
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Fax |
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Provider Business Mailing Address
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Address Line | 301 BALSAM DR
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City | NEW WINDSOR
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State | NY
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Zip | 12553-4755
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Country | US
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Telephone | 845-476-6613
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | TRICIA A HOLNESS
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Credential | LCSW
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Telephone | 845-476-6613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0798201
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License Number State | NY
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