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General NPI Number Information
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NPI Number | 1578878427
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Entity Type | Organization
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Legal Business Name | DIVINITY YOUTH AND FAMILY SERVICES
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Dates
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Enumeration Date | 08/16/2010
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Last Update Date | 11/02/2010
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Provider Practice Location Address
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Address Line | 108 CAMBRIDGE DR
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City | CEDAR HILL
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State | TX
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Zip | 75104-2716
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Country | US
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Telephone | 469-245-9640
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Fax | 972-291-1342
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Provider Business Mailing Address
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Address Line | 108 CAMBRIDGE DR
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City | CEDAR HILL
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State | TX
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Zip | 75104-2716
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Country | US
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Telephone | 469-245-9640
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Fax | 972-291-1342
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Authorized Official
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Title or Position | FOUNDER
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Name | LOLA M GARRETT-SPEARS
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Credential | LBSW
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Telephone | 469-245-9640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 52756
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License Number State | TX
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