Provider Demographics
NPI:1679013015
Name:DIVINE GUIDANCE CENTER, LLC
Entity Type:Organization
Organization Name:DIVINE GUIDANCE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:TONI
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MSSA, LISW-S
Authorized Official - Phone:216-778-9357
Mailing Address - Street 1:1799 AKRON PENINSULA RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-4847
Mailing Address - Country:US
Mailing Address - Phone:330-922-1333
Mailing Address - Fax:
Practice Address - Street 1:1799 AKRON PENINSULA RD
Practice Address - Street 2:SUITE 205
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-4847
Practice Address - Country:US
Practice Address - Phone:330-922-1333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-05
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1101404-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty