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General NPI Number Information
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NPI Number | 1912730011
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Entity Type | Organization
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Legal Business Name | DIVINE BEHAVIORAL SOLUTIONS
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Dates
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Enumeration Date | 08/23/2024
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Last Update Date | 08/23/2024
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Provider Practice Location Address
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Address Line | 830 MAYFIELD ST
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City | TAYLORSVILLE
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State | MS
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Zip | 39168
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Country | US
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Telephone | 601-421-5034
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 17552
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City | HATTIESBURG
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State | MS
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Zip | 39404-7552
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PATRICK SURRELL
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Credential |
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Telephone | 601-421-5034
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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