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General NPI Number Information
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NPI Number | 1699040139
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Entity Type | Organization
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Legal Business Name | DESTINY COUNSELING, LLC
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Dates
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Enumeration Date | 03/16/2012
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Last Update Date | 03/16/2012
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Provider Practice Location Address
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Address Line | 630 ALICIA RD
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City | LAKELAND
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State | FL
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Zip | 33801
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Country | US
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Telephone | 863-680-1950
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2702
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City | WINTER HAVEN
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State | FL
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Zip | 33883-2702
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Country | US
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Telephone | 863-206-7227
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Fax |
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Authorized Official
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Title or Position | LICENSED MENTAL HEALTH COUNSELOR
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Name | MS. PATRICIA FAYE KNIGHT-MILLER
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Credential | LMHC
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Telephone | 863-206-7227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH7238
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License Number State | FL
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