1245399203 NPI number — DIVINE INTERVENTIONS COUNSELING CENTER, PLLC

Table of content: (NPI 1245399203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245399203 NPI number — DIVINE INTERVENTIONS COUNSELING CENTER, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIVINE INTERVENTIONS COUNSELING CENTER, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245399203
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 3001
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILSON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27895-3001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-234-2048
Provider Business Mailing Address Fax Number:
252-234-2047

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3704 TRACE DR W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILSON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27893-8347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-245-2048
Provider Business Practice Location Address Fax Number:
888-634-1369
Provider Enumeration Date:
12/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
YANKOSKY
Authorized Official First Name:
JANET
Authorized Official Middle Name:
ELEANORE
Authorized Official Title or Position:
LICENSED CLINICAL SOCIAL WORKER
Authorized Official Telephone Number:
252-245-2048

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  C004270 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1379H . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2113388 . This is a "CIGNA PROVIDER NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com