Provider Demographics
NPI:1649158635
Name:DIVINE GRACE RESOURCE CENTER INC
Entity type:Organization
Organization Name:DIVINE GRACE RESOURCE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MBUYI
Authorized Official - Middle Name:
Authorized Official - Last Name:KALONJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-826-7175
Mailing Address - Street 1:870 LANGLEY FARMS DR
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-7960
Mailing Address - Country:US
Mailing Address - Phone:678-826-7175
Mailing Address - Fax:
Practice Address - Street 1:870 LANGLEY FARMS DR
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-7960
Practice Address - Country:US
Practice Address - Phone:678-826-7175
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?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty