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General NPI Number Information
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NPI Number | 1881445955
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Entity Type | Organization
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Legal Business Name | DESTINATION WELLNESS COUNSELING, PLLC
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Dates
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Enumeration Date | 03/28/2024
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Last Update Date | 03/28/2024
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Provider Practice Location Address
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Address Line | 5900 BALCONES DR # 19129
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City | AUSTIN
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State | TX
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Zip | 78731-4257
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Country | US
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Telephone | 832-819-4641
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Fax |
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Provider Business Mailing Address
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Address Line | 5900 BALCONES DR # 19129
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City | AUSTIN
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State | TX
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Zip | 78731-4257
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Country | US
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Telephone | 832-819-4641
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | MS. SHANICA M. JONES
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Credential | LPC
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Telephone | 509-768-2249
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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