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General NPI Number Information
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NPI Number | 1417521907
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Entity Type | Organization
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Legal Business Name | DIVINE HEALING SPACE, PLLC
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Dates
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Enumeration Date | 05/18/2021
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Last Update Date | 05/18/2021
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Provider Practice Location Address
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Address Line | 12222 MERIT DR # 130
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City | DALLAS
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State | TX
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Zip | 75251-2217
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Country | US
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Telephone | 504-410-0031
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Fax |
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Provider Business Mailing Address
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Address Line | 12222 MERIT DR # 130
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City | DALLAS
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State | TX
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Zip | 75251-2217
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Country | US
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Telephone | 504-410-0031
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Fax |
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Authorized Official
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Title or Position | OWNER/ CLINICAL SOCIAL WORKER
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Name | MRS. JASMINE BATTLES
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Credential | LCSW
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Telephone | 504-410-0031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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