Healthcare Provider Details

I. General information

NPI: 1699040139
Provider Name (Legal Business Name): DESTINY COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2012
Last Update Date: 03/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 ALICIA RD
LAKELAND FL
33801
US

IV. Provider business mailing address

PO BOX 2702
WINTER HAVEN FL
33883-2702
US

V. Phone/Fax

Practice location:
  • Phone: 863-680-1950
  • Fax:
Mailing address:
  • Phone: 863-206-7227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH7238
License Number StateFL

VIII. Authorized Official

Name: MS. PATRICIA FAYE KNIGHT-MILLER
Title or Position: LICENSED MENTAL HEALTH COUNSELOR
Credential: LMHC
Phone: 863-206-7227