=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629371109
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DESTINY COUNSELING & CHRISTIAN THERAPY SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2010
-----------------------------------------------------
Last Update Date | 12/06/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5842 TOVA CIR
-----------------------------------------------------
City | MACUNGIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18062-8460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-751-6091
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5842 TOVA CIR
-----------------------------------------------------
City | MACUNGIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18062-8460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-751-6091
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ LICENSED PROFESSIONAL COUNSE
-----------------------------------------------------
Name | KWABENA BOBIE AMANKWATIA
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 610-751-6091
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | PC004101
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------