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General NPI Number Information
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NPI Number | 1700691615
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Entity Type | Organization
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Legal Business Name | DIVINE LOVE WELLNESS ENTERPRISES LLC
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Dates
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Enumeration Date | 02/08/2025
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Last Update Date | 02/08/2025
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Provider Practice Location Address
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Address Line | 13173 SW 44TH ST
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City | MIRAMAR
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State | FL
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Zip | 33027-3114
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Country | US
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Telephone | 754-280-8805
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Fax |
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Provider Business Mailing Address
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Address Line | 13173 SW 44TH ST
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City | MIRAMAR
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State | FL
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Zip | 33027-3114
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Country | US
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Telephone | 754-280-8805
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Fax |
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Authorized Official
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Title or Position | OWNER, PSYCHOTHERAPIST
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Name | LAURA ARMIDE JEANIS
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Credential | LCSW, LC, CCTP, CTMH
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Telephone | 754-280-8805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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