Provider Demographics
NPI:1659543932
Name:DIVINE INTERVENTION FOR YOUTH INC.
Entity Type:Organization
Organization Name:DIVINE INTERVENTION FOR YOUTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AQUISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:252-947-2012
Mailing Address - Street 1:PO BOX 2982
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889
Mailing Address - Country:US
Mailing Address - Phone:252-789-8378
Mailing Address - Fax:
Practice Address - Street 1:203 GREEN STREET
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892
Practice Address - Country:US
Practice Address - Phone:252-789-8378
Practice Address - Fax:252-789-8379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health