Provider Demographics
NPI:1386252336
Name:DIVINE MERCY, INC.
Entity type:Organization
Organization Name:DIVINE MERCY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:MERCY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-685-2830
Mailing Address - Street 1:1721 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-3119
Mailing Address - Country:US
Mailing Address - Phone:410-685-2830
Mailing Address - Fax:
Practice Address - Street 1:1721 PENNSYLVANIA AVE
Practice Address - Street 2:SUITES 201, 203-206
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-3119
Practice Address - Country:US
Practice Address - Phone:410-685-2830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:T00447068
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-15
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty