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General NPI Number Information
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NPI Number | 1801409313
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Entity Type | Organization
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Legal Business Name | DIVINE BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 08/25/2020
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Last Update Date | 08/25/2020
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Provider Practice Location Address
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Address Line | 8870 YOUREE DR STE 105
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City | SHREVEPORT
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State | LA
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Zip | 71115-2512
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Country | US
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Telephone | 318-347-4994
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Fax |
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Provider Business Mailing Address
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Address Line | 2803 JONATHAN LN
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City | SHREVEPORT
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State | LA
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Zip | 71108-5531
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Country | US
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Telephone | 318-347-4994
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MS. VERONICA DOUGLAS
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Credential | LPC-S
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Telephone | 318-347-4994
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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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