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General NPI Number Information
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NPI Number | 1720900392
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Entity Type | Organization
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Legal Business Name | DESTINEE-4-MOR LLC
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Dates
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Enumeration Date | 07/27/2026
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Last Update Date | 07/27/2026
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Provider Practice Location Address
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Address Line | 861 FOUR POINTS RD W TRLR 22
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City | KEYSVILLE
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State | GA
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Zip | 30816-4554
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Country | US
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Telephone | 478-206-5997
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Fax |
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Provider Business Mailing Address
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Address Line | 861 FOUR POINTS RD W TRLR 22
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City | KEYSVILLE
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State | GA
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Zip | 30816-4554
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Country | US
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Telephone | 478-206-5997
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Fax |
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Authorized Official
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Title or Position | LPC
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Name | MS. AMANDA W BURNETT
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Credential | LPC
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Telephone | 478-206-5997
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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 |
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License Number State |
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