Provider Demographics
NPI:1457717514
Name:DIVINE HEALING AND INTERVENTION
Entity Type:Organization
Organization Name:DIVINE HEALING AND INTERVENTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONYETTE
Authorized Official - Middle Name:MCGILL
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-322-2375
Mailing Address - Street 1:700 W JUDGE PEREZ DR STE 103
Mailing Address - Street 2:
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043-4871
Mailing Address - Country:US
Mailing Address - Phone:504-322-2375
Mailing Address - Fax:504-322-2414
Practice Address - Street 1:700 W JUDGE PEREZ DR STE 103
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-4871
Practice Address - Country:US
Practice Address - Phone:504-322-2375
Practice Address - Fax:504-322-2414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health