Organization
DIVINE 5 SERVICES LLP
Active
Other names
Divine 5 Services LLP
Organization subpart
No
Provider details
NPI number
Authorized official
ELANTE HARRIS CEO (PRESIDENT)
(404) 274-1378
Entity
Organization
Contact information
Practice address
155 BANKERS BLVD STE G100, MONROE, GA 30655-7727
(404) 274-1378
Mailing address
155 BANKERS BLVD STE G100, MONROE, GA 30655-7727
(404) 274-1378
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
343800000X
Secured Medical Transport (VAN)
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
373H00000X
Day Training/Habilitation Specialist
—
—
Other
Enumeration date
09/30/2021
Last updated
09/30/2021
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