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General NPI Number Information
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NPI Number | 1598537458
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Entity Type | Organization
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Legal Business Name | DIVINE RECOVERY SOLUTIONS LLC
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Dates
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Enumeration Date | 10/24/2023
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 101 BUFORD RD STE 203A
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23235-5292
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Country | US
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Telephone | 434-430-1912
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Fax |
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Provider Business Mailing Address
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Address Line | 607 CHURCH ST
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City | EMPORIA
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State | VA
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Zip | 23847-2208
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Country | US
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Telephone | 434-430-1912
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Fax |
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Authorized Official
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Title or Position | MEMBER/CEO
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Name | CASANDRA MILLER
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Credential |
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Telephone | 434-430-1912
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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