Healthcare Provider Details

I. General information

NPI: 1699511485
Provider Name (Legal Business Name): DESTINY ROSE ALDERMAN CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 E MILL ST
CIRCLEVILLE OH
43113-2029
US

IV. Provider business mailing address

29521 KIME HOLDERMAN RD
CIRCLEVILLE OH
43113-9433
US

V. Phone/Fax

Practice location:
  • Phone: 740-500-1402
  • Fax: 740-500-1718
Mailing address:
  • Phone: 740-571-1436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.187692
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: