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General NPI Number Information
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NPI Number | 1649838525
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Entity Type | Organization
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Legal Business Name | THE DESTIN GROUP LLC
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Dates
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Enumeration Date | 06/05/2019
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Last Update Date | 06/05/2019
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Provider Practice Location Address
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Address Line | 8819 PEEBLE BEACH COURT
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City | CHESTERFIELD
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State | VA
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Zip | 23832-2667
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Country | US
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Telephone | 804-381-8337
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Fax |
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Provider Business Mailing Address
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Address Line | 12220 CHATTANOOGA PLZ # 208
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City | MIDLOTHIAN
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State | VA
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Zip | 23112-4865
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Country | US
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Telephone | 804-381-8337
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Fax |
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Authorized Official
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Title or Position | CREDENTIAL
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Name | TAMARA MICHELL WILLIAMS
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Credential |
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Telephone | 804-503-4634
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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