Provider Demographics
NPI:1083354666
Name:DIVINE PURPOSE COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:DIVINE PURPOSE COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:EVELYNANN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:773-633-8695
Mailing Address - Street 1:6024 S PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60621-3316
Mailing Address - Country:US
Mailing Address - Phone:773-633-8695
Mailing Address - Fax:
Practice Address - Street 1:6024 S PRINCETON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-3316
Practice Address - Country:US
Practice Address - Phone:773-633-8695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health