Provider Demographics
NPI:1548023906
Name:DIVINE LIFE THERAPEUTIC SOLUTIONS LLC.
Entity type:Organization
Organization Name:DIVINE LIFE THERAPEUTIC SOLUTIONS LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:EBONY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEAK
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LISW-S
Authorized Official - Phone:513-238-0761
Mailing Address - Street 1:1918 STEVENS AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-4222
Mailing Address - Country:US
Mailing Address - Phone:513-238-0761
Mailing Address - Fax:
Practice Address - Street 1:800 COMPTON RD STE 37B-6
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-3826
Practice Address - Country:US
Practice Address - Phone:513-445-2053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty