Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 37AC00493100 | NJ |
NPI | 1952939571 |
---|---|
Provider Name | Thomas Divins |
First Address | Vernon Hills, IL 60061-1454 |
Second Address | Lyndhurst, NJ 07071-3615 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2020 |
Last Update Date | 30/03/2020 |