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General NPI Number Information
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NPI Number | 1730704933
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Entity Type | Organization
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Legal Business Name | DIVINE DIRECTION ONLINE
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Dates
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Enumeration Date | 06/12/2020
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Last Update Date | 10/29/2020
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Provider Practice Location Address
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Address Line | 3817 WHITE HERON DR
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City | ORLANDO
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State | FL
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Zip | 32808-2605
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Country | US
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Telephone | 407-448-3665
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Fax |
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Provider Business Mailing Address
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Address Line | 3817 WHITE HERON DR
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City | ORLANDO
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State | FL
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Zip | 32808-2605
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Country | US
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Telephone | 407-655-7402
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DONOVAN D. DAVIS
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Credential |
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Telephone | 407-448-3665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 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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