Provider Demographics
NPI:1578878427
Name:DIVINITY YOUTH AND FAMILY SERVICES
Entity Type:Organization
Organization Name:DIVINITY YOUTH AND FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:LOLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GARRETT-SPEARS
Authorized Official - Suffix:
Authorized Official - Credentials:LBSW
Authorized Official - Phone:469-245-9640
Mailing Address - Street 1:108 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-2716
Mailing Address - Country:US
Mailing Address - Phone:469-245-9640
Mailing Address - Fax:972-291-1342
Practice Address - Street 1:108 CAMBRIDGE DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2716
Practice Address - Country:US
Practice Address - Phone:469-245-9640
Practice Address - Fax:972-291-1342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 172V00000X
TX52756251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty