Provider Demographics
NPI:1821286345
Name:DEVINE PSYCHIATRY LLC
Entity Type:Organization
Organization Name:DEVINE PSYCHIATRY LLC
Other - Org Name:COLUMBIA PSYCHIATRIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MILAGROS
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-779-7500
Mailing Address - Street 1:1333 TAYLOR ST
Mailing Address - Street 2:SUITE 4-H
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2923
Mailing Address - Country:US
Mailing Address - Phone:803-779-7500
Mailing Address - Fax:803-779-7522
Practice Address - Street 1:1333 TAYLOR ST
Practice Address - Street 2:SUITE 4-H
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2923
Practice Address - Country:US
Practice Address - Phone:803-779-7500
Practice Address - Fax:803-779-7522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23294302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC232947Medicaid
SCAA05688038 GRP #8038OtherMEDICARE
SC232947Medicaid