Divine Legacy
NPI #1073072260 in Brooklyn Center, Minnesota
Provider Information
- NPI Number
- 1073072260
- Entity Type
- Organization
- Organization Name
- Divine Legacy
- Primary Specialty
- Clinic/Center - Mental Health (Including Community Mental Health Center)
- Enumeration Date
- Mar 18, 2019
- Last Updated
- Mar 18, 2019
Practice Location
- Address
- 3300 COUNTY ROAD 10 STE 318
- City
- Brooklyn Center
- State
- Minnesota
- ZIP Code
- 55429-3066
- Phone
- (763) 439-2588
Authorized Official
- Name
- LAKESIA AYCOCK
- Title
- ADMINISTRATION/MHP
- Phone
- (763) 439-2588
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Corporate Health — Corporate Health |
| Clinic/Center - Adult Mental Health — Adult Mental Health |
| Clinic/Center - Adolescent and Children Mental Health — Adolescent and Children Mental Health |
| Clinic/Center - Mental Health (Including Community Mental Health Center) — Mental Health (Including Community Mental Health Center) |
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