Individual
MR. CHARLES L DIVINEY III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MC, LPC, NCC, CCMHC
Contact information
Practice address
352 DENVER ST, SUITE 215, SALT LAKE CITY, UT 84111-3000
(801) 521-4227
(801) 359-0777
Mailing address
PO BOX 3872, SALT LAKE CITY, UT 84110-3872
(801) 201-4096
(801) 521-4227
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
340426-6004
UT
101YM0800X
Mental Health Counselor
340426-6004
UT
101YP2500X
Professional Counselor
Primary
340426-6004
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34042660001001
BCBS
UT
Enumeration date
04/19/2006
Last updated
07/07/2010
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