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General NPI Number Information
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NPI Number | 1497030928
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Entity Type | Organization
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Legal Business Name | DESTINY ADULT, CHILD & FAMILY SERVICES LLC
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Dates
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Enumeration Date | 10/16/2011
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Last Update Date | 11/17/2023
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Provider Practice Location Address
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Address Line | 701 DISHMAN LANE EXT STE 3
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City | BOWLING GREEN
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State | KY
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Zip | 42104-4033
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Country | US
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Telephone | 270-495-1609
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Fax | 270-599-0399
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Provider Business Mailing Address
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Address Line | 701 DISHMAN LANE EXT STE 3
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City | BOWLING GREEN
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State | KY
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Zip | 42104-4033
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Country | US
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Telephone | 270-495-1609
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Fax | 270-599-0399
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Authorized Official
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Title or Position | OWNER/DIRECTOR OF OPERATIONS
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Name | MARK WADE WATSON
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Credential |
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Telephone | 270-202-3595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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