Provider Demographics
NPI:1215394853
Name:DIVINE COMFORT AND COUNSELING LLC
Entity Type:Organization
Organization Name:DIVINE COMFORT AND COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICDC, LSW
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGETTE
Authorized Official - Middle Name:D
Authorized Official - Last Name:HERREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-301-5549
Mailing Address - Street 1:5818 WILMINGTON PIKE
Mailing Address - Street 2:PMB 207
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-7004
Mailing Address - Country:US
Mailing Address - Phone:937-301-5549
Mailing Address - Fax:
Practice Address - Street 1:1 ELIZABETH PL
Practice Address - Street 2:SEB - 1040
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-3445
Practice Address - Country:US
Practice Address - Phone:937-301-5549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-27
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHICDC.141066251S00000X
OHS.1201403251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health