Provider Demographics
NPI:1477431492
Name:DIVINE HEALING BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:DIVINE HEALING BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARMAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:STITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-993-1535
Mailing Address - Street 1:2944 RAY WEILAND DR
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:LA
Mailing Address - Zip Code:70714-3250
Mailing Address - Country:US
Mailing Address - Phone:225-993-1535
Mailing Address - Fax:
Practice Address - Street 1:3900 LAKELAND DR STE 200
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-8853
Practice Address - Country:US
Practice Address - Phone:225-993-1535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)