Organization
DIVINE PSYCHIATRIC CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY CARSTARPHEN APRN (OWNER)
(251) 402-0450
Entity
Organization
Contact information
Practice address
2651 CEDAR DR, LAWRENCEVILLE, GA 30043-1325
(251) 402-0450
Mailing address
2651 CEDAR DR, LAWRENCEVILLE, GA 30043-1325
(251) 402-0450
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
—
—
Other
Enumeration date
04/23/2017
Last updated
04/23/2017
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