MEDICARE: DESTINY DANAE ALLEN

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	1041S0200X	School Social Worker	PPS-0609619	VA

General Provider Information

NPI Number	:	1376350629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESTINY DANAE ALLEN

Provider Business Mailing Address
First Line	:	3060 PEWTER RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-6420
Country	:	US
Telephone Number	:	540-598-0877
Fax Number	:

Provider Business Practice Location Address
First Line	:	641 CARRIAGE HILL RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-6546
Country	:	US
Telephone Number	:	757-263-2300
Fax Number	:

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

Provider Enumeration Date	:	12/11/2024
Last Update Date	:	06/09/2026

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