| Divine Legends Llc | |
|
555 Fayetteville St Ste 201 Raleigh NC 27601-3034 | |
| (919) 348-6246 | |
| Not Available |
| Full Name | Divine Legends Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 555 Fayetteville St Ste 201, Raleigh, North Carolina |
| Authorized Official Name and Position | Chasity Davis (OWNER) |
| Authorized Official Contact | 9193486246 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Divine Legends Llc Po Box 41071 Raleigh NC 27629-1071 Ph: () - | Divine Legends Llc 555 Fayetteville St Ste 201 Raleigh NC 27601-3034 Ph: (919) 348-6246 |
| NPI Number | 1205352697 |
|---|---|
| Provider Enumeration Date | 08/17/2017 |
| Last Update Date | 06/16/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205352697 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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