The Divine Therapy and Wellness Center

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

THE DIVINE THERAPY AND WELLNESS CENTER

Practice address

5376 Tomah Dr Ste 210
Colorado Springs, CO 80918-6968

Phone

(719) 766-7163

NPI assigned

Feb 5, 2020

Organization subpart

No

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

Authorized official

Name

Andrea V Pacheco, LCSWNPI 1417383035

Title

Owner

Phone

(719) 686-3029

Specialties & licenses 1

Addresses

Other names 1

• The Divine Therapy and Wellness Center Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Locations

Practitioners 1

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

• Andrea Pacheco, LCSW

  • Clinical Social Worker
  • Colorado Springs, CO
  • NPI 1417383035
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1580860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580860800000",
    "number": "1639701873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5376 TOMAH DR STE 210",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809186968",
            "telephone_number": "719-766-7163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5376 TOMAH DR STE 210",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809186968",
            "telephone_number": "719-766-7163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE DIVINE THERAPY AND WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-05",
        "last_updated": "2020-02-05",
        "certification_date": "2020-02-05",
        "status": "A",
        "authorized_official_last_name": "PACHECO",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "719-686-3029",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "divinetherapycenter@gmail.com",
            "affiliation": "N",
            "address_1": "5376 Tomah Dr Ste 210",
            "city": "Colorado Springs",
            "state": "CO",
            "country_code": "US",
            "postal_code": "809186968",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "The Divine Therapy and Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2020; 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.