CHARLES L DIVINEY III MC LPC NCC
Physician Assistant in Salt Lake City, UT

License number
Utah 340426-6004
Category
Social Work
Type
Professional
License number
Utah 5170621-6004
Category
Social Work
Type
Professional
License number
Utah 6281940-3501
Category
Social Work
Type
Clinical
License number
Utah 210158-4405
Category
Physician Assistant
Type
Psychiatric/Mental Health
Owner
Name: CHARLES L DIVINEY III MC LCMHC NCC, PHD MC LCMHC NCC PHD.
Title: OWNER/THERAPIST
Phone: (801) 521-4227
Address
Address
352 So Denver St. #215, Salt Lake City, UT 84110
National Provider ID: 1235447772
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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CHARLES L DIVINEY III, MC, LPC, NCC, LLC

Salt Lake City, UT

Industry:
Specialty Outpatient Clinic
Registration:
Oct 27, 2006
Addresses:
352 S Denver St STE 215, Salt Lake City, UT 84111 (Physical)
PO Box 3872, Salt Lake City, UT 84110
State ID:
6371112-0160
Business type:
LLC - Domestic
Allied Health Professional, Chief Executive Officer, Director, Executive Director, Owner, Psychologist:
Chuck Diviney (Allied Health Professional, Chief Executive Officer, Director, Executive Director, Owner, Psychologist)
Agent:
Charles L Diviney,PO Box 3872, Salt Lake City, UT 84110 (Physical)

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