| NPI | 1316562218 |
|---|---|
| Former Legal Business Name | DIVINE SOURCE |
| Entity Type | Organization |
| Authorized Contact | BARBARA M GILLAM Licensed Clinical Social Work 615-428-4425 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2020-06-16 |
| Last Update Date | 2020-06-16 |