Divine Intervention Recovery Center, LLC

NPI #1912648528 in Enon, Ohio

Provider Information

NPI Number: 1912648528
Entity Type: Organization
Organization Name: Divine Intervention Recovery Center, LLC
Primary Specialty: Clinic/Center - Mental Health (Including Community Mental Health Center)
Enumeration Date: Apr 6, 2022
Last Updated: Oct 10, 2022

Practice Location

Address: 7373 DAYTON SPRINGFIELD RD
City: Enon
State: Ohio
ZIP Code: 45323-1462
Phone: (937) 862-0008

Authorized Official

Name: FAYETTA J BARRON, LISWS
Title: OWNER
Phone: (937) 241-9230

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor - Addiction (Substance Use Disorder) — Addiction (Substance Use Disorder)	101YA0400X
Internal Medicine - Addiction Medicine — Addiction Medicine	207RA0401X
Clinic/Center - Mental Health (Including Community Mental Health Center) — Mental Health (Including Community Mental Health Center)	261QM0801X	Primary

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