| The Divine Therapy And Wellness Center | |
|
5376 Tomah Dr Ste 210 Colorado Springs CO 80918-6968 | |
| (719) 766-7163 | |
| Not Available |
| Full Name | The Divine Therapy And Wellness Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 5376 Tomah Dr Ste 210, Colorado Springs, Colorado |
| Authorized Official Name and Position | Andrea V Pacheco (OWNER) |
| Authorized Official Contact | 7196863029 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Divine Therapy And Wellness Center 5376 Tomah Dr Ste 210 Colorado Springs CO 80918-6968 Ph: (719) 766-7163 | The Divine Therapy And Wellness Center 5376 Tomah Dr Ste 210 Colorado Springs CO 80918-6968 Ph: (719) 766-7163 |
| NPI Number | 1639701873 |
|---|---|
| Provider Enumeration Date | 02/05/2020 |
| Last Update Date | 02/05/2020 |
| Certification Date | 02/05/2020 |
| Medicare PECOS PAC ID | 9739516311 |
|---|---|
| Medicare Enrollment ID | O20200220000326 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639701873 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Andrea Valentina Pacheco |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417383035 PECOS PAC ID: 3173899416 Enrollment ID: I20180731001519 |
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