1184822157 NPI number — DESTINY ADULT & CHILDREN COUNSELING CTR

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184822157 NPI number — DESTINY ADULT & CHILDREN COUNSELING CTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DESTINY ADULT & CHILDREN COUNSELING CTR
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184822157
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 SE 17TH ST
Provider Second Line Business Mailing Address:
SUITE 801
Provider Business Mailing Address City Name:
OCALA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34471-5178
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-622-4888
Provider Business Mailing Address Fax Number:
352-694-4884

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 SE 17TH ST
Provider Second Line Business Practice Location Address:
SUITE 801
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34471-5178
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-622-4888
Provider Business Practice Location Address Fax Number:
352-694-4884
Provider Enumeration Date:
07/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OIBO
Authorized Official First Name:
MERCY
Authorized Official Middle Name:
U
Authorized Official Title or Position:
DIRECTOR/MENTAL HEALTH COUNSELOR
Authorized Official Telephone Number:
352-622-4888

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  7369 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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