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General NPI Number Information
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NPI Number | 1679491823
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Entity Type | Organization
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Legal Business Name | DIVINE DESIGN PSYCHOTHERAPY PLLC
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Dates
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Enumeration Date | 07/07/2026
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Last Update Date | 07/07/2026
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Provider Practice Location Address
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Address Line | 1735 S KENSINGTON AVE
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City | KANKAKEE
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State | IL
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Zip | 60901-8095
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Country | US
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Telephone | 815-545-6701
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Fax | 510-370-4034
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Provider Business Mailing Address
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Address Line | 1735 S KENSINGTON AVE
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City | KANKAKEE
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State | IL
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Zip | 60901-8095
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Country | US
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Telephone | 815-545-6701
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Fax | 510-370-4034
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | ROBYN CARAVELLO
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Credential | LCPC
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Telephone | 815-545-6701
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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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