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General NPI Number Information
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NPI Number | 1679116156
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Entity Type | Organization
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Legal Business Name | DIVINE PURPOSE SERVICES LIMITED LLC
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Dates
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Enumeration Date | 10/28/2019
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Last Update Date | 02/21/2020
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Provider Practice Location Address
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Address Line | 2025 EBENEZER RD STE J4
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City | ROCK HILL
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State | SC
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Zip | 29732-1079
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Country | US
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Telephone | 704-300-5544
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Fax |
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Provider Business Mailing Address
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Address Line | 100 LESLIE DR
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City | SHELBY
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State | NC
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Zip | 28152-0757
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Country | US
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Telephone | 704-300-5544
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRANDY USSERY
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Credential |
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Telephone | 704-300-5544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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