Organization
DIVINE RECOVERY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHEILA JEAN BURGE (CEO)
(919) 529-0325
Entity
Organization
Contact information
Practice address
2775 CLIFTON AVE, CREEDMOOR, NC 27522-9511
(919) 529-0325
Mailing address
2775 CLIFTON AVE, CREEDMOOR, NC 27522-9511
(919) 529-0325
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
2084B0040X
Behavioral Neurology & Neuropsychiatry Physician
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Enumeration date
06/24/2019
Last updated
07/09/2019
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