Provider Demographics
NPI:1013523976
Name:DIVINE MIND COUNSELING AND CONSULTING SERVICES
Entity Type:Organization
Organization Name:DIVINE MIND COUNSELING AND CONSULTING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:CUPKA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:616-308-3184
Mailing Address - Street 1:2450 44TH ST SE STE 205
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49512-9081
Mailing Address - Country:US
Mailing Address - Phone:616-308-3184
Mailing Address - Fax:
Practice Address - Street 1:2450 44TH ST SE STE 205
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49512-9081
Practice Address - Country:US
Practice Address - Phone:616-308-3184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty