Provider Demographics
NPI:1679116156
Name:DIVINE PURPOSE SERVICES LIMITED LLC
Entity Type:Organization
Organization Name:DIVINE PURPOSE SERVICES LIMITED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:USSERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-300-5544
Mailing Address - Street 1:100 LESLIE DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152-0757
Mailing Address - Country:US
Mailing Address - Phone:704-300-5544
Mailing Address - Fax:
Practice Address - Street 1:2025 EBENEZER RD STE J4
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1079
Practice Address - Country:US
Practice Address - Phone:704-300-5544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-28
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health