Organization
DESTILEE LLC
Active
Other names
Destilee Health Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VANESSA CHAPPELL LEE PH.D. (OWNER)
(443) 244-7615
Entity
Organization
Contact information
Practice address
6104 WHITTEMORE CT, UPPER MARLBORO, MD 20772-4155
(443) 244-7615
Mailing address
6104 WHITTEMORE CT, UPPER MARLBORO, MD 20772-4155
(443) 244-7615
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
643495
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12530000
—
MD
Enumeration date
08/21/2015
Last updated
08/21/2015
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