Organization Active NPI

The Great Divine Center LLC

  • Mental Health Counselor
  • Detroit, MI
National Provider Identifier
1902558091
Registry record updated Jan 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
THE GREAT DIVINE CENTER LLC
Practice address
17169 E Warren Ave
Detroit, MI 48224-2279
Phone
(313) 480-4766
NPI assigned
Jan 20, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2022

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

Authorized official

Name
Kymaletha Brown, LLPCNPI 1407371529
Title
Counselor/Owner
Phone
(313) 480-4766

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary
Community Health Clinic/Center 261QC1500X
Multi-Specialty Clinic/Center 261QM1300X

Addresses

Primary practice location

17169 E Warren Ave
Detroit, MI 48224-2279

Mailing address

17163 E Warren Ave
Detroit, MI 48224-2279
Phone (313) 480-4766

National Provider Directory

National Provider Directory

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": "1642636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642636800000",
    "number": "1902558091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17163 E WARREN AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482242279",
            "telephone_number": "313-480-4766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17169 E WARREN AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482242279",
            "telephone_number": "313-480-4766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE GREAT DIVINE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-20",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-08",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "KYMALETHA",
        "authorized_official_title_or_position": "COUNSELOR/OWNER",
        "authorized_official_telephone_number": "313-480-4766",
        "authorized_official_credential": "LLPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 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.