Provider Demographics
NPI:1982778940
Name:LINDA DIVINE, LSCSW, LLC
Entity Type:Organization
Organization Name:LINDA DIVINE, LSCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIVINE
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW, LLC
Authorized Official - Phone:913-341-7447
Mailing Address - Street 1:8340 MISSION RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66206-1355
Mailing Address - Country:US
Mailing Address - Phone:913-341-7447
Mailing Address - Fax:913-341-7262
Practice Address - Street 1:8340 MISSION RD
Practice Address - Street 2:SUITE 230
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66206-1355
Practice Address - Country:US
Practice Address - Phone:913-341-7447
Practice Address - Fax:913-341-7262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW08381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSS34022Medicare UPIN
KS0009748Medicare ID - Type Unspecified