Provider Demographics
NPI:1801568761
Name:DIVERGENT ROADS COUNSELING
Entity type:Organization
Organization Name:DIVERGENT ROADS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:LA REA
Authorized Official - Last Name:HATCHETT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:423-368-5893
Mailing Address - Street 1:417 COUNTY ROAD 709
Mailing Address - Street 2:
Mailing Address - City:RICEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37370-5331
Mailing Address - Country:US
Mailing Address - Phone:423-368-5893
Mailing Address - Fax:
Practice Address - Street 1:3505 ADKISSON DR NW STE 205
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-6805
Practice Address - Country:US
Practice Address - Phone:423-368-5893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty