Provider Demographics
NPI:1386396687
Name:A DIVINE COUNSELING & CONSULTING SERVICES PROFESSIONAL LLC
Entity type:Organization
Organization Name:A DIVINE COUNSELING & CONSULTING SERVICES PROFESSIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHATANA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS-COBB
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:702-635-7306
Mailing Address - Street 1:5332 MOUNTAIN GARLAND LN
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-4034
Mailing Address - Country:US
Mailing Address - Phone:702-635-7306
Mailing Address - Fax:
Practice Address - Street 1:5135 CAMINO AL NORTE STE 258
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-2419
Practice Address - Country:US
Practice Address - Phone:702-635-7306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)