Provider Demographics
NPI:1205603842
Name:DIVINE GRACE INTEGRATIVE PSYCHIATRY PLLC
Entity type:Organization
Organization Name:DIVINE GRACE INTEGRATIVE PSYCHIATRY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:N/S
Authorized Official - Prefix:
Authorized Official - First Name:CHIOMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORJI
Authorized Official - Suffix:
Authorized Official - Credentials:N/S
Authorized Official - Phone:832-361-7867
Mailing Address - Street 1:PO BOX 710013
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77271-0013
Mailing Address - Country:US
Mailing Address - Phone:832-361-7867
Mailing Address - Fax:
Practice Address - Street 1:16718 W BELLFORT ST # 103
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-3251
Practice Address - Country:US
Practice Address - Phone:832-361-7867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-05
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty