Provider Demographics
NPI:1689409955
Name:DIVERGE COUNSELING LLC
Entity type:Organization
Organization Name:DIVERGE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MADELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, ATR
Authorized Official - Phone:814-900-4562
Mailing Address - Street 1:2800 W 21ST ST STE 102
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-2980
Mailing Address - Country:US
Mailing Address - Phone:814-900-4562
Mailing Address - Fax:814-731-6496
Practice Address - Street 1:2800 W 21ST ST STE 102
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-2980
Practice Address - Country:US
Practice Address - Phone:814-900-4562
Practice Address - Fax:814-731-6496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty