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General NPI Number Information
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NPI Number | 1295607620
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Entity Type | Organization
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Legal Business Name | HEART HEAL WITH HERLAY DIVINE LICENSED CLINICAL SOCIAL WORK INC
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Dates
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Enumeration Date | 09/23/2025
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 323 N TURNER AVE UNIT 1012
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City | GUASTI
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State | CA
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Zip | 91743-1603
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Country | US
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Telephone | 909-472-1272
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Fax |
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Provider Business Mailing Address
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Address Line | 4181 FLAT ROCK DR STE 300
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City | RIVERSIDE
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State | CA
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Zip | 92505-7106
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Country | US
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Telephone | 909-472-1272
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | HERLAY DIVINE
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Credential | LCSW
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Telephone | 909-472-1272
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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 |
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License Number State |
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