NPIMap

Organization Active NPI

Divine Psychology, LLC

  • Clinical Psychologist
  • Marietta, GA
National Provider Identifier
1003320888
Registry record updated May 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY003469 Issued in GA
Legal business name
DIVINE PSYCHOLOGY, LLC
Practice address
4343 Shallowford Rd Ste G3
Marietta, GA 30062-5021
Phone
(678) 626-7207
NPI assigned
Dec 1, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 28, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Sara Velez, PSYDNPI 1982879425
Title
Clinical Psychologist & Owner
Phone
(678) 626-7207

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Cognitive & Behavioral PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TB0200X PSY003469 GA
Clinical PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC0700X PSY003469 GA Primary
Health PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TH0004X PSY003469 GA
Rehabilitation PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TR0400X PSY003469 GA

Addresses

Primary practice location

4343 Shallowford Rd Ste G3
Marietta, GA 30062-5021

Mailing address

2960 Silverplume Dr
Fort Collins, CO 80526-2488
Phone (678) 626-7207

National Provider Directory

National Provider Directory

Locations

645 Hembree Pkwy
Ste A
Roswell, GA 30076

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1512086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622160000000",
    "number": "1003320888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2960 SILVERPLUME DR",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805262488",
            "telephone_number": "678-626-7207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4343 SHALLOWFORD RD STE G3",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300625021",
            "telephone_number": "678-626-7207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE PSYCHOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-01",
        "last_updated": "2021-05-28",
        "certification_date": "2021-05-28",
        "status": "A",
        "authorized_official_last_name": "VELEZ",
        "authorized_official_first_name": "SARA",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST & OWNER",
        "authorized_official_telephone_number": "678-626-7207",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "GA",
            "license": "PSY003469",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "PSY003469",
            "primary": true
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Health",
            "state": "GA",
            "license": "PSY003469",
            "primary": false
        },
        {
            "code": "103TR0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Rehabilitation",
            "state": "GA",
            "license": "PSY003469",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.