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General NPI Number Information
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NPI Number | 1205603842
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Entity Type | Organization
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Legal Business Name | DIVINE GRACE INTEGRATIVE PSYCHIATRY PLLC
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Dates
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Enumeration Date | 12/05/2023
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 16718 W BELLFORT ST # 103
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City | RICHMOND
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State | TX
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Zip | 77407-3251
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Country | US
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Telephone | 832-361-7867
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 710013
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City | HOUSTON
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State | TX
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Zip | 77271-0013
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Country | US
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Telephone | 832-361-7867
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Fax |
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Authorized Official
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Title or Position | N/S
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Name | CHIOMA ORJI
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Credential | N/S
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Telephone | 832-361-7867
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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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