Provider Demographics
NPI:1326705682
Name:DIVINE LOVE & HEALING CLINICAL COUNSELING & CARE
Entity Type:Organization
Organization Name:DIVINE LOVE & HEALING CLINICAL COUNSELING & CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:PIEDRAHITA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, LMHFT
Authorized Official - Phone:786-343-4474
Mailing Address - Street 1:1870 NW 106TH TER
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-3536
Mailing Address - Country:US
Mailing Address - Phone:786-343-4474
Mailing Address - Fax:
Practice Address - Street 1:1870 NW 106TH TER
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-3536
Practice Address - Country:US
Practice Address - Phone:786-343-4474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty