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Organization
NEW DESTINY CLINIC
Active
Organization
NEW DESTINY CLINIC
Active
Other names
none
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BILL ETIENNE WILSON (CEO)
(408) 791-4817
Entity
Organization
Contact information
Practice address
5251 W CAMPBELL AVE STE 204, PHOENIX, AZ 85031-1719
(480) 258-8703
Mailing address
5251 W CAMPBELL AVE STE 204, PHOENIX, AZ 85031-1719
(408) 791-4817
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
OTC13126
—
AZ
Enumeration date
01/29/2024
Last updated
04/30/2025
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