| Divine Source | |
|
141 Country Club Dr Hendersonville TN 37075-4041 | |
| (615) 428-4425 | |
| Not Available |
| Full Name | Divine Source |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 141 Country Club Dr, Hendersonville, Tennessee |
| Authorized Official Name and Position | Barbara M Gillam (LICENSED CLINICAL SOCIAL WORK) |
| Authorized Official Contact | 6154284425 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Divine Source 141 Country Club Dr Hendersonville TN 37075-4041 Ph: (615) 428-4425 | Divine Source 141 Country Club Dr Hendersonville TN 37075-4041 Ph: (615) 428-4425 |
| NPI Number | 1316562218 |
|---|---|
| Provider Enumeration Date | 06/16/2020 |
| Last Update Date | 06/16/2020 |
| Certification Date | 06/16/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316562218 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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