Provider Demographics
NPI:1477894962
Name:DIVINE INDIVIDUALS COUNSELING SERVICES, INC.
Entity Type:Organization
Organization Name:DIVINE INDIVIDUALS COUNSELING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-739-6883
Mailing Address - Street 1:5104 N ORANGE BLOSSOM TRL STE 107
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-1013
Mailing Address - Country:US
Mailing Address - Phone:407-739-6883
Mailing Address - Fax:
Practice Address - Street 1:5104 N ORANGE BLOSSOM TRL STE 107
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-1013
Practice Address - Country:US
Practice Address - Phone:407-739-6883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-07
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty