Provider Demographics
NPI:1417521907
Name:DIVINE HEALING SPACE, PLLC
Entity Type:Organization
Organization Name:DIVINE HEALING SPACE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BATTLES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:504-410-0031
Mailing Address - Street 1:12222 MERIT DR # 130
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-2217
Mailing Address - Country:US
Mailing Address - Phone:504-410-0031
Mailing Address - Fax:
Practice Address - Street 1:12222 MERIT DR # 130
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-2217
Practice Address - Country:US
Practice Address - Phone:504-410-0031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty