Healthcare Provider Details

I. General information

NPI: 1780169995
Provider Name (Legal Business Name): DESTINY MCCAIN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2018
Last Update Date: 04/04/2026
Certification Date: 04/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 W HIGHWAY 50
O FALLON IL
62269-1827
US

IV. Provider business mailing address

816 W CLAY ST
COLLINSVILLE IL
62234-3106
US

V. Phone/Fax

Practice location:
  • Phone: 618-792-5200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberTPMC7516
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2025034155
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.018012
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: