Healthcare Provider Details

I. General information

NPI: 1063632966
Provider Name (Legal Business Name): THE NEW DESTINY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 09/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 W WASHINGTON BLVD SUITE 517
LOS ANGELES CA
90015-3552
US

IV. Provider business mailing address

155 WEST WASHINGTON BLVD S SUITE 517
LOS ANGELES CA
90015-0000
US

V. Phone/Fax

Practice location:
  • Phone: 323-304-0054
  • Fax: 213-749-1540
Mailing address:
  • Phone: 323-304-0054
  • Fax: 213-749-1540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number101YA0400X
License Number StateCA

VIII. Authorized Official

Name: MR. NII AHUMA OCANSEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 323-304-0054