Organization
DIVINE INTERVENTION RECOVERY CENTER, LLC
Active
Other names
Divine Intervention Recovery Center
Organization subpart
No
Provider details
NPI number
Authorized official
FAYETTA J BARRON LISWS (OWNER)
(937) 241-9230
Entity
Organization
Contact information
Practice address
7373 DAYTON SPRINGFIELD RD, ENON, OH 45323-1462
(937) 862-0008
(937) 340-7004
Mailing address
7373 DAYTON SPRINGFIELD RD, ENON, OH 45323-1462
(937) 862-0008
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
207RA0401X
Addiction Medicine (Internal Medicine) Physician
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
04/06/2022
Last updated
10/10/2022
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