Individual
LORELLE M DESTEFANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
6600 VAN AALST BLVD, FORT BENNING, GA 31905-2102
(850) 855-4523
Mailing address
6600 VAN AALST BLVD, FORT BENNING, GA 31905-2102
(850) 855-4523
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
0904009238
VA
1041C0700X
Clinical Social Worker
0904009238
VA
1041C0700X
Clinical Social Worker
Primary
SW16232
FL
Other
Enumeration date
03/03/2016
Last updated
03/05/2025
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