Organization
DIVINE PURPOSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VERNITA KAYE ELLIS (LICENSE PROFESSIONAL COUNSELOR)
(804) 520-1366
Entity
Organization
Contact information
Practice address
24816 BRICKWOOD MEADOW LN, NORTH DINWIDDIE, VA 23803-8869
(804) 520-1366
Mailing address
17305 GATEWOOD RD, DINWIDDIE, VA 23841-2619
(804) 520-1366
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
0701005361
VA
Other
Enumeration date
09/11/2014
Last updated
09/11/2014
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