Provider Demographics
NPI:1487159505
Name:DANIELS, DESTINY
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 SPRING HAVEN LOOP APT 100
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-9437
Mailing Address - Country:US
Mailing Address - Phone:813-464-4413
Mailing Address - Fax:727-372-1908
Practice Address - Street 1:403 SPRING HAVEN LOOP APT 100
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-9437
Practice Address - Country:US
Practice Address - Phone:813-464-4413
Practice Address - Fax:727-372-1908
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician