Organization
DIVINE THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE FANT CHILDERS LCSW (DIRECTOR)
(501) 213-1077
Entity
Organization
Contact information
Practice address
209 ROYA LN STE 4, BRYANT, AR 72022-2669
(501) 213-1077
Mailing address
209 ROYA LN STE 4, BRYANT, AR 72022-2669
(501) 213-1077
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C1416
AR
Other
Enumeration date
08/11/2017
Last updated
01/01/2025
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