| NPI | 1235447772 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES L DIVINEY III MC LCMHC NCC, PHD Owner/Therapist 801-521-4227 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: UT 340426-6004) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: UT 5170621-6004) |
| 1041C0700X Social Worker, Clinical (Licence: UT 6281940-3501) | |
| 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: UT 210158-4405) | |
| Enumeration Date | 2010-09-17 |
| Last Update Date | 2012-11-21 |