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General NPI Number Information
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NPI Number | 1700749728
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Entity Type | Individual
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Provider Name | DESTINY PETERSON BACH
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Gender | Female
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Dates
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Enumeration Date | 12/05/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 169 SAXONY RD STE 205
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City | ENCINITAS
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State | CA
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Zip | 92024-6780
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Country | US
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Telephone | 619-929-2843
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 880013
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City | SAN DIEGO
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State | CA
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Zip | 92168-0013
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Country | US
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Telephone | 619-300-3698
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 152871
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License Number State | CA
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