Healthcare Provider Details

I. General information

NPI: 1518639160
Provider Name (Legal Business Name): DESTIN COUNSELING AND CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 BENNING DR STE 1
DESTIN FL
32541-2432
US

IV. Provider business mailing address

120 BENNING DR STE 1
DESTIN FL
32541-2432
US

V. Phone/Fax

Practice location:
  • Phone: 850-710-0295
  • Fax: 833-208-6587
Mailing address:
  • Phone: 850-687-4333
  • Fax: 833-208-6587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESSICA LEIGH STILLA
Title or Position: OWNER/PROVIDER
Credential: LMHC, ATR-BC
Phone: 850-710-0295