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NPI Code Detail

MEDICARE: MRS. PAMELLA B DIVINITY

MEDICARE: MRS. PAMELLA B DIVINITY
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator6656LA
2101YP2500XProfessional Counselor6656LA

General Provider Information

NPI Number : 1356891246
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. PAMELLA B DIVINITY
Provider Business Mailing Address
First Line : PO BOX 1385
Second Line : 12434 HOLLINS ROAD
City : FOLSOM
State : LA
Zip : 70437-1385
Country : US
Telephone Number : 985-237-4930
Fax Number :
Provider Business Practice Location Address
First Line : 2150 GENERAL PERSHING ST
Second Line :
City : MANDEVILLE
State : LA
Zip : 70448-5125
Country : US
Telephone Number : 985-465-4250
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2016
Last Update Date : 12/10/2018

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Directions to “ MRS. PAMELLA B DIVINITY ” Practice Location

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