# DIVINE PSYCHIATRIC CARE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306373170
- **Authorized official:** TRACY CARSTARPHEN APRN (OWNER/PROVIDER)
- **Authorized official phone:** (251) 402-0450

## Contact information

- **Practice address:** 2651 CEDAR DR, LAWRENCEVILLE, GA 30043-1325
- **Practice address phone:** (251) 402-0450
- **Mailing address:** 2651 CEDAR DR, LAWRENCEVILLE, GA 30043-1325
- **Mailing address phone:** (251) 402-0450

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | RN165081 | GA | Yes |

## Other

- **Enumeration date:** 05/11/2017
- **Last updated:** 05/11/2017