Provider Demographics
NPI:1144057027
Name:DIVINE TOUCH BEHAVIORAL HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:DIVINE TOUCH BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:HOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-559-5944
Mailing Address - Street 1:3757 JOHNSTON RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31601-2105
Mailing Address - Country:US
Mailing Address - Phone:229-460-5248
Mailing Address - Fax:229-559-7760
Practice Address - Street 1:3757 JOHNSTON RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-2105
Practice Address - Country:US
Practice Address - Phone:229-460-5248
Practice Address - Fax:229-559-7760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty