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General NPI Number Information
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NPI Number | 1497576680
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Entity Type | Organization
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Legal Business Name | DESTINATION WELLNESS THERAPY PLLC
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Dates
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Enumeration Date | 10/21/2024
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 108 GILES AVE STE 102
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City | WILMINGTON
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State | NC
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Zip | 28403-4759
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Country | US
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Telephone | 252-560-0777
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Fax |
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Provider Business Mailing Address
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Address Line | 2610 SOFT SKY LN
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City | WILMINGTON
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State | NC
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Zip | 28409-5831
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Country | US
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Telephone | 252-560-0777
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LINDSAY HAYES
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Credential |
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Telephone | 252-560-0777
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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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