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General NPI Number Information
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NPI Number | 1598657884
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Entity Type | Organization
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Legal Business Name | DIVINE GRIND WELLNESS, LLC
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Dates
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Enumeration Date | 07/19/2025
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 1514 HOLLYWOOD AVE
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City | GAINESVILLE
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State | GA
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Zip | 30501-1608
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Country | US
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Telephone | 470-768-1610
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Fax |
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Provider Business Mailing Address
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Address Line | 1514 HOLLYWOOD AVE
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City | GAINESVILLE
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State | GA
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Zip | 30501-1608
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Country | US
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Telephone | 470-768-1610
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Fax |
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Authorized Official
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Title or Position | DIRECT OWNER
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Name | STACEY HUFF
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Credential | LPC
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Telephone | 706-499-3250
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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 |
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License Number State |
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