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General NPI Number Information
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NPI Number | 1811870306
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Entity Type | Organization
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Legal Business Name | THE DIVERGENT GROVE THERAPY LLC
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Dates
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Enumeration Date | 07/30/2025
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 4753 NARVIK DRIVE
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City | EAGAN
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State | MN
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Zip | 55122
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Country | US
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Telephone | 651-998-7438
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Fax | 651-705-7077
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Provider Business Mailing Address
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Address Line | 7851 METRO PKWY #115 PMB1099
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City | BLOOMINGTON
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State | MN
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Zip | 55425
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Country | US
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Telephone | 651-998-7438
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Fax | 651-705-7077
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR/FOUNDER
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Name | ALEXANDRA DIVERGENT GROVE THER MCLAUGHLIN
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Credential |
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Telephone | 651-998-7438
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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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