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General NPI Number Information
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NPI Number | 1356749303
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Entity Type | Individual
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Provider Name | FREEDAH DESTINY EXAVIER MS
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Gender | Female
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Dates
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Enumeration Date | 12/08/2014
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 1601 NE BRAILLE PL
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City | JENSEN BEACH
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State | FL
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Zip | 34957-5345
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Country | US
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Telephone | 561-906-4743
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Fax | 772-444-3735
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Provider Business Mailing Address
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Address Line | 718 SW BYRON ST
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City | PORT ST LUCIE
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State | FL
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Zip | 34983-1922
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Country | US
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Telephone | 561-906-4743
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 19949
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License Number State | FL
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