MEDICARE: DEVINE COUNSELING AND WELLNESS ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0850X	Adult Mental Health Clinic/Center
2	261QR1300X	Rural Health Clinic/Center
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1295578284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEVINE COUNSELING AND WELLNESS ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	207 W HONDO AVE
Second Line	:
City	:	DEVINE
State	:	TX
Zip	:	78016-2922
Country	:	US
Telephone Number	:	830-224-0024
Fax Number	:	830-224-0030

Provider Business Practice Location Address
First Line	:	207 W HONDO AVE
Second Line	:
City	:	DEVINE
State	:	TX
Zip	:	78016-2922
Country	:	US
Telephone Number	:	830-224-0024
Fax Number	:	830-224-0030

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. VONNA SMITH
Credential	:	LCSW
Telephone Number	:	210-632-2728

Provider Enumeration Date	:	06/17/2024
Last Update Date	:	05/05/2026

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