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General NPI Number Information
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NPI Number | 1326254582
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Entity Type | Organization
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Legal Business Name | DIVINE GUIDANCE INTEGRATIVE SERVICES
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 07/31/2007
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Provider Practice Location Address
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Address Line | 1306 DUSK CT
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City | GREENVILLE
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State | NC
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Zip | 27834-7785
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Country | US
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Telephone | 252-830-1802
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Fax | 252-695-6026
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Provider Business Mailing Address
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Address Line | 2317 EXECUTIVE CIR SUITE B
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City | GREENVILLE
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State | NC
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Zip | 27834-3762
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Country | US
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Telephone | 252-695-6040
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Fax | 252-695-6026
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Authorized Official
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Title or Position | DIRECTOR
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Name | JEFFREY WARD
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Credential |
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Telephone | 252-714-9056
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | MHL-074-184
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License Number State | NC
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