Provider Demographics
NPI:1568613545
Name:DIVINE, TAMBRA K
Entity type:Individual
Prefix:MRS
First Name:TAMBRA
Middle Name:K
Last Name:DIVINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2358 FIELDGATE DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-7360
Mailing Address - Country:US
Mailing Address - Phone:925-768-0785
Mailing Address - Fax:925-608-5188
Practice Address - Street 1:2500 BATES AVE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-1376
Practice Address - Country:US
Practice Address - Phone:925-326-0479
Practice Address - Fax:925-608-5188
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No172V00000XOther Service ProvidersCommunity Health Worker
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist