Provider Demographics
NPI:1578939260
Name:DEVINE INTERVENTIONS INC.
Entity Type:Organization
Organization Name:DEVINE INTERVENTIONS INC.
Other - Org Name:CHILDREN OF PROMISE SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLEVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:601-213-0896
Mailing Address - Street 1:1478 KRISTEN DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-2115
Mailing Address - Country:US
Mailing Address - Phone:601-213-0896
Mailing Address - Fax:601-213-0973
Practice Address - Street 1:514 CAMPBELL ST
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MS
Practice Address - Zip Code:38967-2519
Practice Address - Country:US
Practice Address - Phone:601-213-0896
Practice Address - Fax:601-213-0973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM7245101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty