Organization
DIVINE DESTINY BEHAVIOR HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA JONES FULTON LPC (OWNER)
(843) 401-9217
Entity
Organization
Contact information
Practice address
19 EMIEL C. BAKER ROAD, SALTERS, SC 29590
(843) 401-9217
Mailing address
PO BOX 978, KINGSTREE, SC 29556-0978
(843) 401-9217
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
02/15/2023
Last updated
02/15/2023
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