Divine Mind Therapeutics LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

DIVINE MIND THERAPEUTICS LLC

Practice address

1806 Summit Ave Set 300 PMB 2034
Richmond, VA 23230

Phone

(571) 249-2519

NPI assigned

Aug 10, 2022

Last updated

Aug 10, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shannon Johnson, LPC-LCPC-MFTNPI 1881066140

Title

Coo

Phone

(202) 766-4216

Specialties & licenses 1

Addresses

Electronic endpoints 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shannon Johnson, M.S

  • Marriage & Family Therapist
  • Jacksonville, FL
  • NPI 1881066140
  NPD Authorized official
• Stefanie Charisse Jackson, LMFT

  • Marriage & Family Therapist
  • Atlanta, GA
  • NPI 1891324430
  NPD

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

{
    "created_epoch": "1660089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660089600000",
    "number": "1407584204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 CONNECTICUT AVE NW APT B2",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200081451",
            "telephone_number": "202-766-4216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1806 SUMMIT AVE SET 300 PMB 2034",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "23230",
            "telephone_number": "571-249-2519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE MIND THERAPEUTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-10",
        "last_updated": "2022-08-10",
        "certification_date": "2022-08-05",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "202-766-4216",
        "authorized_official_credential": "LPC-LCPC-MFT"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://secure.simplepractice.com",
            "affiliation": "N",
            "endpointDescription": "EHR System",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Not Applicable",
            "address_1": "1806 Summit Ave SET 300 PMB 2034",
            "city": "Richmond",
            "state": "VA",
            "country_code": "US",
            "postal_code": "23230",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Guy Andrew Ditommaso, DC
• Diversity Inhome Supports, LLC
• Diversity Residential Homes
• Diversity Training & Support Center
• Divine Kings & Queens
• Divine Minds Youth Services
• Divine Pathways Support Services LLC
• Divine Residential Services, LLC
• Divine Residential Services, LLC. (Divine Transformation)
• Thomas James Dix, DDS

• Mental Health Counselor in Richmond, VA
• Providers in Richmond, VA by specialty
• Mental Health Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2022; 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.