Provider Demographics
NPI:1922808534
Name:DEVINE INTERVENTIONS BEHAVIORAL HEALTH CLINIC LLC
Entity type:Organization
Organization Name:DEVINE INTERVENTIONS BEHAVIORAL HEALTH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:DORSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-433-7084
Mailing Address - Street 1:3209 MARYFIELD LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-4457
Mailing Address - Country:US
Mailing Address - Phone:804-433-7084
Mailing Address - Fax:
Practice Address - Street 1:3209 MARYFIELD LN
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-4457
Practice Address - Country:US
Practice Address - Phone:804-433-7084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-14
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase ManagementGroup - Single Specialty