Provider Demographics
NPI:1073748190
Name:DIVIND BEHAVIORAL SERVICES,INC
Entity Type:Organization
Organization Name:DIVIND BEHAVIORAL SERVICES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:PACITA
Authorized Official - Last Name:GODDARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-833-6291
Mailing Address - Street 1:13813 WARWICK BLVD
Mailing Address - Street 2:200
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602
Mailing Address - Country:US
Mailing Address - Phone:757-833-6291
Mailing Address - Fax:
Practice Address - Street 1:13813 WARWICK BLVD
Practice Address - Street 2:200
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-3755
Practice Address - Country:US
Practice Address - Phone:757-833-6291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness