Provider Demographics
NPI:1275256976
Name:DIVINE RACE MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:DIVINE RACE MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCH NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ANNASTECIA
Authorized Official - Middle Name:CHINASA
Authorized Official - Last Name:OKIBE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:832-692-7100
Mailing Address - Street 1:10193 W GRAND PKWY S STE 103202
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-8685
Mailing Address - Country:US
Mailing Address - Phone:832-693-7100
Mailing Address - Fax:
Practice Address - Street 1:10193 W GRAND PKWY S STE 103202
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-8685
Practice Address - Country:US
Practice Address - Phone:832-693-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)