| Divine Therapy, Llc | |
|
209 Roya Ln Ste 4 Bryant AR 72022-2669 | |
| (501) 213-1077 | |
| Not Available |
| Full Name | Divine Therapy, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 209 Roya Ln Ste 4, Bryant, Arkansas |
| Authorized Official Name and Position | Julie Fant (DIRECTOR) |
| Authorized Official Contact | 5012131077 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Divine Therapy, Llc 209 Roya Ln Ste 4 Bryant AR 72022-2669 Ph: (501) 213-1077 | Divine Therapy, Llc 209 Roya Ln Ste 4 Bryant AR 72022-2669 Ph: (501) 213-1077 |
| NPI Number | 1669997599 |
|---|---|
| Provider Enumeration Date | 08/11/2017 |
| Last Update Date | 07/21/2022 |
| Certification Date | 11/03/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669997599 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | C1416 (Arkansas) | Primary |
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