| Divine Treatment Center Llc | |
|
3707 E Southern Ave Ste 2077 Mesa AZ 85206-6219 | |
| (602) 394-5989 | |
| Not Available |
| Full Name | Divine Treatment Center Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 3707 E Southern Ave Ste 2077, Mesa, Arizona |
| Authorized Official Name and Position | Carnot Munyandamutsa (ADMINISTRATOR) |
| Authorized Official Contact | 6023945989 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Divine Treatment Center Llc 3707 E Southern Ave Ste 2079 Mesa AZ 85206-6219 Ph: (602) 394-5989 | Divine Treatment Center Llc 3707 E Southern Ave Ste 2077 Mesa AZ 85206-6219 Ph: (602) 394-5989 |
| NPI Number | 1063192292 |
|---|---|
| Provider Enumeration Date | 07/21/2023 |
| Last Update Date | 07/21/2023 |
| Certification Date | 07/20/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063192292 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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