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General NPI Number Information
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NPI Number | 1578097069
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Entity Type | Organization
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Legal Business Name | ENHANCED DESTINY SERVICES
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Dates
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Enumeration Date | 04/12/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 406 RAYBURN RD
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City | CARRIERE
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State | MS
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Zip | 39426-8381
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Country | US
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Telephone | 601-590-6526
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Fax |
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Provider Business Mailing Address
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Address Line | 406 RAYBURN RD
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City | CARRIERE
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State | MS
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Zip | 39426-8381
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | HUMAN RESOURCES
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Name | LISA ELLIS
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Credential |
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Telephone | 504-373-6877
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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 | LA
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