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General NPI Number Information
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NPI Number | 1275256976
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Entity Type | Organization
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Legal Business Name | DIVINE RACE MENTAL HEALTH SERVICES
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Dates
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Enumeration Date | 09/19/2022
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Last Update Date | 09/19/2022
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Provider Practice Location Address
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Address Line | 10193 W GRAND PKWY S STE 103202
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City | RICHMOND
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State | TX
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Zip | 77407-8685
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Country | US
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Telephone | 832-693-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 10193 W GRAND PKWY S STE 103202
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City | RICHMOND
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State | TX
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Zip | 77407-8685
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Country | US
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Telephone | 832-693-7100
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Fax |
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Authorized Official
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Title or Position | PSYCH NURSE PRACTITIONER
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Name | ANNASTECIA CHINASA OKIBE
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Credential | PMHNP-BC
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Telephone | 832-692-7100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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