Provider Demographics
NPI:1821167842
Name:DIVINE, ELIZABETH BETTY (LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BETTY
Last Name:DIVINE
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5855 DOLIVER DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-2474
Mailing Address - Country:US
Mailing Address - Phone:713-857-7755
Mailing Address - Fax:713-627-7715
Practice Address - Street 1:4803 SAN FELIPE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-3907
Practice Address - Country:US
Practice Address - Phone:713-626-7990
Practice Address - Fax:713-627-7715
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLCDC8902101YA0400X
TXLPC17841101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health