Provider Demographics
NPI:1013367598
Name:DIVINE OPTIONS, CORP.
Entity Type:Organization
Organization Name:DIVINE OPTIONS, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:BARRERA
Authorized Official - Suffix:
Authorized Official - Credentials:LSP
Authorized Official - Phone:305-785-3422
Mailing Address - Street 1:56 TRUMAN DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3111
Mailing Address - Country:US
Mailing Address - Phone:305-785-3422
Mailing Address - Fax:
Practice Address - Street 1:56 TRUMAN DR
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3111
Practice Address - Country:US
Practice Address - Phone:305-785-3422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS00000575251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health