Organization · NPI-2

A Divine Time LLC

Clinic/Center, Adult Mental Health · Charlotte, NC

NPI number1346979093

StatusActive

Last updated in NPPESOct 10, 2022

Details

NPI: 1346979093
Entity type: Organization (NPI-2)
Legal business name: A Divine Time LLC
Organization subpart: No
Enumeration date: Jun 8, 2022
Certification date: Oct 10, 2022
Last updated: Oct 10, 2022

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
261QM0850X	Clinic/Center, Adult Mental Health	–	–	Yes
101YA0400X	Counselor, Addiction (Substance Use Disorder)	–	–
101Y00000X	Counselor	–	–
101YM0800X	Counselor, Mental Health	–	–
1041C0700X	Social Worker, Clinical	–	–
175T00000X	Peer Specialist	–	–
207Q00000X	Family Medicine	–	–
207QA0401X	Family Medicine, Addiction Medicine	–	–
207QA0505X	Family Medicine, Adult Medicine	–	–
261Q00000X	Clinic/Center	–	–
261QM0801X	Clinic/Center, Mental Health (Including Community Mental Health Center)	–	–
261QM0855X	Clinic/Center, Adolescent and Children Mental Health	–	–

Practice location

8539 Monroe Rd # 123
Charlotte, NC 28212-7510

Phone 336-541-3485

Mailing address

8539 Monroe Rd Ste 123
Charlotte, NC 28212-7510

Phone 704-707-3799 · Fax 704-817-9585

Authorized official

Tressa Corbett
Administrator
3365413485

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