Individual
CORY S DIVINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CSAC, LPC
Contact information
Practice address
6402 ODANA RD STE 106, MADISON, WI 53719-1123
(608) 220-8627
Mailing address
6402 ODANA RD STE 106, MADISON, WI 53719-1123
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
15367-132
WI
101YP2500X
Professional Counselor
Primary
6901-125
WI
Other
Enumeration date
03/13/2007
Last updated
01/02/2025
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