| Divine Wellness Therapeutic Center Pllc | |
|
3077 N Main St Ste 201 Hope Mills NC 28348-1735 | |
| (910) 275-5766 | |
| (866) 990-0668 |
| Full Name | Divine Wellness Therapeutic Center Pllc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 3077 N Main St Ste 201, Hope Mills, North Carolina |
| Authorized Official Name and Position | Robyn Ann Mirassou (OWNER) |
| Authorized Official Contact | 9106707340 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Divine Wellness Therapeutic Center Pllc 3077 N Main St Ste 201 Hope Mills NC 28348-1735 Ph: (910) 275-5766 | Divine Wellness Therapeutic Center Pllc 3077 N Main St Ste 201 Hope Mills NC 28348-1735 Ph: (910) 275-5766 |
| NPI Number | 1578291308 |
|---|---|
| Provider Enumeration Date | 08/10/2022 |
| Last Update Date | 08/10/2022 |
| Certification Date | 08/10/2022 |
| Medicare PECOS PAC ID | 9931546751 |
|---|---|
| Medicare Enrollment ID | O20240328000530 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578291308 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Robyn Ann Mirassou |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1235788647 PECOS PAC ID: 0840637666 Enrollment ID: I20240328000741 |
| Provider Name | Donald Lee Sanders |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1942871264 PECOS PAC ID: 8325402738 Enrollment ID: I20240411002422 |
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