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General NPI Number Information
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NPI Number | 1932955580
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Entity Type | Organization
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Legal Business Name | DESTINED HORIZONS MENTAL HEALTH PRACTICE PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 04/25/2024
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Last Update Date | 04/25/2024
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Provider Practice Location Address
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Address Line | 1312 EAST 54TH STREET
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City | BROOKLYN
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State | NY
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Zip | 11234
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Country | US
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Telephone | 347-232-3809
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Fax |
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Provider Business Mailing Address
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Address Line | 323 BLACKSEED DR
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City | GRAYSON
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State | GA
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Zip | 30017-4305
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Country | US
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Telephone | 347-232-3809
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CARMY ARISTOR
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Credential | LMHC
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Telephone | 347-232-3809
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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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