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General NPI Number Information
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NPI Number | 1750011730
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Entity Type | Organization
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Legal Business Name | DESTINY CONNECTIONS LLC
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Dates
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Enumeration Date | 06/13/2022
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Last Update Date | 06/13/2022
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Provider Practice Location Address
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Address Line | 9022 COLUMBIA AVE
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City | CLEVELAND
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State | OH
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Zip | 44108-2904
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Country | US
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Telephone | 216-372-6812
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Fax |
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Provider Business Mailing Address
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Address Line | 9022 COLUMBIA AVE
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City | CLEVELAND
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State | OH
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Zip | 44108-2904
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. MIRRIAM KNIGHT
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Credential | PSYD
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Telephone | 216-372-6812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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