Organization
DIVINELY DIRECTED SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RODERICK S. HAWTHORNE SR. DMIN (CHIEF ADMINISTRATIVE OFFICER)
(757) 558-6914
Entity
Organization
Contact information
Practice address
2909 ARCADIA AVE, PORTSMOUTH, VA 23704-6055
(757) 397-9058
(757) 558-6915
Mailing address
961 CANAL DR, SUITE B, CHESAPEAKE, VA 23323-4766
(757) 558-6914
(757) 558-6915
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
1075-14-001
VA
Other
Enumeration date
09/16/2009
Last updated
09/16/2009
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