Provider Demographics
NPI:1447669908
Name:KASTURI, DIVYA S (LPC)
Entity type:Individual
Prefix:
First Name:DIVYA
Middle Name:S
Last Name:KASTURI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 CAMELLIA BLVD STE I00
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7248
Mailing Address - Country:US
Mailing Address - Phone:337-781-6791
Mailing Address - Fax:
Practice Address - Street 1:1007 CAMELLIA BLVD STE I00
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7248
Practice Address - Country:US
Practice Address - Phone:337-781-6791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-10
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5263101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health