Provider Demographics
NPI:1285329540
Name:DIVERSE INTERVENTIONS SOCIAL AND BEHAVIORAL SCIENCES, LLC
Entity type:Organization
Organization Name:DIVERSE INTERVENTIONS SOCIAL AND BEHAVIORAL SCIENCES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:LI'CHELE'
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:813-531-5380
Mailing Address - Street 1:PO BOX 1526
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33583-1526
Mailing Address - Country:US
Mailing Address - Phone:813-531-5380
Mailing Address - Fax:
Practice Address - Street 1:501 SPORTSMAN PARK DR
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-4153
Practice Address - Country:US
Practice Address - Phone:813-531-5380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251S00000XAgenciesCommunity/Behavioral Health