Healthcare Provider Details

I. General information

NPI: 1184047318
Provider Name (Legal Business Name): DESTINY DAGNAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2014
Last Update Date: 01/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 LIBERTY HILL RD
CAMDEN SC
29020-1871
US

IV. Provider business mailing address

215 N MAGNOLIA ST
SUMTER SC
29150-4943
US

V. Phone/Fax

Practice location:
  • Phone: 803-423-5323
  • Fax: 803-713-3978
Mailing address:
  • Phone: 803-775-9364
  • Fax: 803-773-6615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: