19D2309341 CLIA NUMBER - DIVINITY DIAGNOSTIC & WELLNESS INC

Laboratory Demographics

  • CLIA Code: 19D2309341
  • Facility Name: DIVINITY DIAGNOSTIC & WELLNESS INC
  • Facility Address: 2002 20TH ST, SUITE 202 B
    KENNER, LA
    ZIP 70062
  • Facility Phone: 504 667-3641
  • Facility Type: Independent
  • Facility Type: Waiver
  • Lab Director: LATEDA T. WILLIAMS
  • NPI Number: 1336992437
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 19D2309341
LAB Type Independent
Facility Name DIVINITY DIAGNOSTIC & WELLNESS INC
Street 2002 20TH ST, SUITE 202 B
City KENNER
State LA
ZIP 70062
Phone 504 667-3641
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/13/2024
Certificate Expiration Date 8/12/2026
Facility Type Independent
Lab Director LATEDA T. WILLIAMS

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This page was last updated on: 9/29/2025