Divine, Cory S

Divine, Cory S is an sole proprietor health care provider with primary practice located at 6402 Odana Rd Ste 106 , Madison WI 53719-1123. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder). Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) is his primary health care specialty. Divine, Cory S can be contacted via phone (608) 220-8627.

Contact Information

Primary practice address
6402 Odana Rd Ste 106 Madison WI 53719-1123
Phone: (608) 220-8627
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 6901-125 Wisconsin
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 15367-132 Wisconsin

Profile Details

NPI number 1558494211
LBN Legal business name Divine, Cory S
Credentials CSAC
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 13th, 2007
Last updated Aug 18th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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