Healthcare Provider Details

I. General information

NPI: 1073023685
Provider Name (Legal Business Name): CHOOSING DESTINY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2017
Last Update Date: 10/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 WHITE AVE
CRAFTON PA
15205-2847
US

IV. Provider business mailing address

121 PATTERSON AVE
CARNEGIE PA
15106-2826
US

V. Phone/Fax

Practice location:
  • Phone: 765-404-0885
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberMF000889
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberMF000889
License Number StatePA

VIII. Authorized Official

Name: MRS. BRIANNA S TOTTY
Title or Position: OWNER
Credential: LMFT
Phone: 765-404-0885