Provider Demographics
NPI:1134806094
Name:DIVINE MENTAL HEALTH & WELLNESS GROUP LLC
Entity type:Organization
Organization Name:DIVINE MENTAL HEALTH & WELLNESS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP -BC
Authorized Official - Prefix:
Authorized Official - First Name:ABIMBOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ODEDAIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-534-3545
Mailing Address - Street 1:18350 ARCOLA BAY LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-1112
Mailing Address - Country:US
Mailing Address - Phone:713-534-3545
Mailing Address - Fax:
Practice Address - Street 1:18350 ARCOLA BAY LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-1112
Practice Address - Country:US
Practice Address - Phone:713-534-3545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty