Provider Demographics
NPI:1407537186
Name:DIVINE COUNSELING LLC
Entity Type:Organization
Organization Name:DIVINE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-796-5089
Mailing Address - Street 1:1829 REISTERSTOWN RD STE 350
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-7126
Mailing Address - Country:US
Mailing Address - Phone:443-955-2662
Mailing Address - Fax:
Practice Address - Street 1:90 PAINTERS MILL RD STE 136
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-3610
Practice Address - Country:US
Practice Address - Phone:443-955-2662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIVINE COUNSELING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty