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General NPI Number Information
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NPI Number | 1265744775
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Entity Type | Organization
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Legal Business Name | DESTINY ENTERPRISES
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Dates
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Enumeration Date | 07/13/2010
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Last Update Date | 07/13/2010
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Provider Practice Location Address
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Address Line | 7226 LEBANON TRL
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City | DAVISON
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State | MI
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Zip | 48423-2300
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Country | US
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Telephone | 810-820-7435
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Fax | 810-820-7438
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Provider Business Mailing Address
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Address Line | 7226 LEBANON TRL
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City | DAVISON
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State | MI
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Zip | 48423-2300
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Country | US
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Telephone | 810-820-7435
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Fax | 810-820-7438
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. JESSICA MCNAYR
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Credential | CRC, LLPC
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Telephone | 810-820-7435
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6401010253
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 00099158
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 00099158
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License Number State | MI
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