Provider Demographics
NPI:1972388775
Name:DIVINE MINDS LLC
Entity type:Organization
Organization Name:DIVINE MINDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TENISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-429-7780
Mailing Address - Street 1:13701 US HIGHWAY 29 STE 3
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:VA
Mailing Address - Zip Code:24531-3611
Mailing Address - Country:US
Mailing Address - Phone:434-429-7780
Mailing Address - Fax:434-433-2063
Practice Address - Street 1:13701 US HIGHWAY 29 STE 3
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:VA
Practice Address - Zip Code:24531-3611
Practice Address - Country:US
Practice Address - Phone:434-429-7780
Practice Address - Fax:434-433-2063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-29
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty