Organization
A DIVINE TIME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRESSA CORBETT LCSW (ADMINISTRATOR)
(336) 541-3485
Entity
Organization
Contact information
Practice address
8539 MONROE RD # 123, CHARLOTTE, NC 28212-7510
(336) 541-3485
Mailing address
8539 MONROE RD STE 123, CHARLOTTE, NC 28212-7510
(704) 707-3799
(704) 817-9585
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
175T00000X
Peer Specialist
—
—
207Q00000X
Family Medicine Physician
—
—
207QA0401X
Addiction Medicine (Family Medicine) Physician
—
—
207QA0505X
Adult Medicine Physician
—
—
261Q00000X
Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00556313
—
NC
05
—
1114265337
—
NC
Enumeration date
06/08/2022
Last updated
10/10/2022
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