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General NPI Number Information
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NPI Number | 1336039858
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Entity Type | Organization
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Legal Business Name | FULL DESTINY COUNSELING, LLC
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Dates
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Enumeration Date | 07/07/2025
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 101 KATELYN CIR STE C
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City | WARNER ROBINS
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State | GA
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Zip | 31088-6484
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Country | US
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Telephone | 678-664-8742
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Fax | 844-853-5737
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Provider Business Mailing Address
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Address Line | 719 BRODERICK CIR
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City | WARNER ROBINS
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State | GA
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Zip | 31088-2415
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Country | US
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Telephone | 478-919-8904
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Fax | 844-853-5737
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Authorized Official
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Title or Position | LPC/ OWNER
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Name | HEATHER W PRUNTY
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Credential |
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Telephone | 478-919-8904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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