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General NPI Number Information
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NPI Number | 1578706198
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Entity Type | Individual
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Provider Name | DANA LYN DIVINE M.ED.
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Gender | Female
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Dates
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Enumeration Date | 04/13/2009
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Last Update Date | 04/13/2009
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Provider Practice Location Address
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Address Line | 2232 INDIANA AVE SUITE ONE
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City | LUBBOCK
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State | TX
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Zip | 79410-2139
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Country | US
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Telephone | 806-793-6160
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Fax | 806-799-0825
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Provider Business Mailing Address
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Address Line | 2232 INDIANA AVE SUITE ONE
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City | LUBBOCK
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State | TX
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Zip | 79410-2139
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Country | US
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Telephone | 806-793-6160
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Fax | 806-799-0825
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 17300
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License Number State | TX
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