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General NPI Number Information
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NPI Number | 1245766690
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Entity Type | Organization
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Legal Business Name | DEVINE INTERVENTIONS GROUP
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Dates
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Enumeration Date | 05/04/2017
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Last Update Date | 08/27/2024
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Provider Practice Location Address
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Address Line | 6757 GREENE STREET OFFICES AT SUMMIT PREBYTERIAN, SUITE 200-C
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City | PHILADELPHIA
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State | PA
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Zip | 19119-3711
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Country | US
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Telephone | 855-410-8120
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Fax | 215-874-8897
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Provider Business Mailing Address
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Address Line | 6757 GREENE STREET OFFICES AT SUMMIT PREBYTERIAN, SUITE 200-C
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City | PHILADELPHIA
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State | PA
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Zip | 19119-3711
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Country | US
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Telephone | 855-410-8120
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Fax | 215-874-8897
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Authorized Official
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Title or Position | LPC
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Name | MR. GARY JAMES DEVINE
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Credential | MA
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Telephone | 267-428-0321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | PC007555
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License Number State | PA
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