MEDICARE: DESTINI ELKINS LCSW

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	1041C0700X	Clinical Social Worker	259496	KY

General Provider Information

NPI Number	:	1689405185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESTINI ELKINS LCSW

Provider Business Mailing Address
First Line	:	2285 EXECUTIVE DR STE 325
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40505-4883
Country	:	US
Telephone Number	:	859-251-8782
Fax Number	:

Provider Business Practice Location Address
First Line	:	2285 EXECUTIVE DR STE 325
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40505-4883
Country	:	US
Telephone Number	:	859-251-8782
Fax Number	:

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

Provider Enumeration Date	:	08/08/2024
Last Update Date	:	08/08/2024

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Directions to “ DESTINI ELKINS LCSW” Practice Location

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