| Divergent Dietitian | |
|
308 Louisiana Ave Perrysburg OH 43551-1461 | |
| (567) 801-0792 | |
| Not Available |
| Full Name | Divergent Dietitian |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 308 Louisiana Ave, Perrysburg, Ohio |
| Authorized Official Name and Position | Bethany Anne Dario (OWNER) |
| Authorized Official Contact | 4194103541 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Divergent Dietitian 308 Louisiana Ave Perrysburg OH 43551-1461 Ph: (419) 410-3541 | Divergent Dietitian 308 Louisiana Ave Perrysburg OH 43551-1461 Ph: (567) 801-0792 |
| NPI Number | 1083463749 |
|---|---|
| Provider Enumeration Date | 05/15/2024 |
| Last Update Date | 05/15/2024 |
| Certification Date | 05/15/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083463749 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
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