Provider Demographics
NPI:1609573518
Name:DIVINE COUNSELING SERVICE, LLC
Entity Type:Organization
Organization Name:DIVINE COUNSELING SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:ALEXIA
Authorized Official - Last Name:JEFFREY
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC, MAC, SAP, QCC
Authorized Official - Phone:832-338-6350
Mailing Address - Street 1:6201 BONHOMME RD STE 174N
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-4367
Mailing Address - Country:US
Mailing Address - Phone:832-864-3347
Mailing Address - Fax:
Practice Address - Street 1:6201 BONHOMME RD STE 174N
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-4367
Practice Address - Country:US
Practice Address - Phone:832-864-3347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-10
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No251B00000XAgenciesCase Management
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder