Organization
DIVINELY ME HOLISTIC CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EBONY JOHNSON (ADMINISTRATOR)
(832) 777-3892
Entity
Organization
Contact information
Practice address
12840 S KIRKWOOD RD APT 126, STAFFORD, TX 77477-3829
(832) 777-3892
Mailing address
12840 S KIRKWOOD RD APT 126, STAFFORD, TX 77477-3829
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
05/14/2020
Last updated
05/14/2020
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