MEDICARE: DESTINY E'SHUNDA THOMAS HUFF

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	8085	LA
2	171M00000X	Case Manager/Care Coordinator
3	101YM0800X	Mental Health Counselor	LPC008731	GA

General Provider Information

NPI Number	:	1003245630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESTINY E'SHUNDA THOMAS HUFF

Provider Business Mailing Address
First Line	:	7626 CRAIG DR
Second Line	:
City	:	FORT BENNING
State	:	GA
Zip	:	31905-7913
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7626 CRAIG DR
Second Line	:
City	:	FORT BENNING
State	:	GA
Zip	:	31905-7913
Country	:	US
Telephone Number	:	706-751-7264
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2013
Last Update Date	:	02/24/2023

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