Provider Demographics
NPI:1124574991
Name:DIVINE COUNSELING AND WELLNESS INC
Entity Type:Organization
Organization Name:DIVINE COUNSELING AND WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOLNESS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:845-476-6613
Mailing Address - Street 1:301 BALSAM DR
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-4755
Mailing Address - Country:US
Mailing Address - Phone:845-476-6613
Mailing Address - Fax:
Practice Address - Street 1:5020 ROUTE 9W
Practice Address - Street 2:SUITE 104
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-7900
Practice Address - Country:US
Practice Address - Phone:845-237-2862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07982011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty