Organization Active NPI

Divine Counseling and Wellness Inc

  • Clinical Social Worker
  • Newburgh, NY
National Provider Identifier
1124574991
Registry record updated Nov 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
0798201 Issued in NY
Legal business name
DIVINE COUNSELING AND WELLNESS INC
Practice address
5020 Route 9W
Suite 104
Newburgh, NY 12550-7900
Phone
(845) 237-2862
NPI assigned
Aug 31, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2018

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

Authorized official

Name
Tricia A Holness, LCSWNPI 1336483031
Title
Therapist
Phone
(845) 476-6613

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X 0798201 NY Primary

Addresses

Primary practice location

5020 Route 9W
Suite 104
Newburgh, NY 12550-7900

Mailing address

301 Balsam Dr
New Windsor, NY 12553-4755
Phone (845) 476-6613

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190405000819 NY Part B Supplier - Clinic/Group Practice 1052652724 Receives reassigned benefits from 1 practitioner
Practice locations: Newburgh, NY

National Provider Directory

National Provider Directory

Locations

5020 Route 9W
Ste 104
Newburgh, NY 12550
Phone (845) 237-2862

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": "1472601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543363200000",
    "number": "1124574991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 BALSAM DR",
            "city": "NEW WINDSOR",
            "state": "NY",
            "postal_code": "125534755",
            "telephone_number": "845-476-6613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5020 ROUTE 9W",
            "address_2": "SUITE 104",
            "city": "NEWBURGH",
            "state": "NY",
            "postal_code": "125507900",
            "telephone_number": "845-237-2862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE COUNSELING AND WELLNESS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-31",
        "last_updated": "2018-11-28",
        "status": "A",
        "authorized_official_last_name": "HOLNESS",
        "authorized_official_first_name": "TRICIA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "845-476-6613",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "0798201",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newburgh, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.