Healthcare Provider Details

I. General information

NPI: 1033049010
Provider Name (Legal Business Name): DESTINY SALLY-KAY ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 S WASHINGTON ST
MANCELONA MI
49659-9649
US

IV. Provider business mailing address

208 S WASHINGTON ST
MANCELONA MI
49659-9649
US

V. Phone/Fax

Practice location:
  • Phone: 231-268-0360
  • Fax: 231-268-0360
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number234139019903
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: