| Divine Interventions Behavioral Health Llc | |
|
10 Canebrake Blvd Ste 110-17 Flowood MS 39232-2211 | |
| (769) 300-1012 | |
| (844) 444-0779 |
| Full Name | Divine Interventions Behavioral Health Llc |
|---|---|
| Speciality | Social Worker |
| Location | 10 Canebrake Blvd Ste 110-17, Flowood, Mississippi |
| Authorized Official Name and Position | Chasity Davis (OWNER/PRESIDENT) |
| Authorized Official Contact | 7693001012 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Divine Interventions Behavioral Health Llc 10 Canebrake Blvd Ste 110-17 Flowood MS 39232-2211 Ph: (769) 300-1012 | Divine Interventions Behavioral Health Llc 10 Canebrake Blvd Ste 110-17 Flowood MS 39232-2211 Ph: (769) 300-1012 |
| NPI Number | 1942813597 |
|---|---|
| Provider Enumeration Date | 08/24/2020 |
| Last Update Date | 10/12/2022 |
| Certification Date | 10/12/2022 |
| Medicare PECOS PAC ID | 6901298868 |
|---|---|
| Medicare Enrollment ID | O20220126002574 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942813597 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| Provider Name | Chasity Davis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215138946 PECOS PAC ID: 9537551494 Enrollment ID: I20220126002825 |
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