Provider Demographics
NPI:1790224327
Name:DIVINOCOUNSELINGASSOCIATES
Entity type:Organization
Organization Name:DIVINOCOUNSELINGASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DIVINO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:303-440-8810
Mailing Address - Street 1:1455 YARMOUTH AVE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-4371
Mailing Address - Country:US
Mailing Address - Phone:303-440-8810
Mailing Address - Fax:303-484-3100
Practice Address - Street 1:1455 YARMOUTH AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-4371
Practice Address - Country:US
Practice Address - Phone:303-440-8810
Practice Address - Fax:303-484-3100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0001359103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty