Provider Demographics
NPI:1053990978
Name:DIVINE RECOVERY THERAPY LLC
Entity type:Organization
Organization Name:DIVINE RECOVERY THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HORN-HOOKS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-291-2550
Mailing Address - Street 1:PO BOX 581
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08528-0581
Mailing Address - Country:US
Mailing Address - Phone:732-785-4323
Mailing Address - Fax:
Practice Address - Street 1:1 AUER CT
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5823
Practice Address - Country:US
Practice Address - Phone:732-785-4323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty