Provider Demographics
NPI:1598961765
Name:DIVINE DELIVERANCE COUNSELING CENTER
Entity Type:Organization
Organization Name:DIVINE DELIVERANCE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFTON
Authorized Official - Middle Name:JUNIOR
Authorized Official - Last Name:RUGGS
Authorized Official - Suffix:III
Authorized Official - Credentials:DMIN, LPC, CASAC
Authorized Official - Phone:573-774-5894
Mailing Address - Street 1:100 S BATES ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65583-2146
Mailing Address - Country:US
Mailing Address - Phone:573-774-5894
Mailing Address - Fax:573-774-6975
Practice Address - Street 1:100 S BATES ST
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65583-2146
Practice Address - Country:US
Practice Address - Phone:573-774-5894
Practice Address - Fax:573-774-6975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002680322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children