Provider Demographics
NPI:1871864173
Name:DIVINE CONSULTING SERVICES, INC
Entity Type:Organization
Organization Name:DIVINE CONSULTING SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:DURDEN
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:475-455-2092
Mailing Address - Street 1:5910 GA HIGHWAY 21 S
Mailing Address - Street 2:UNIT 6
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-5505
Mailing Address - Country:US
Mailing Address - Phone:912-988-3649
Mailing Address - Fax:888-572-7924
Practice Address - Street 1:5910 GA HIGHWAY 21 S
Practice Address - Street 2:UNIT 6
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-5505
Practice Address - Country:US
Practice Address - Phone:912-988-3649
Practice Address - Fax:888-572-7924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health