Individual
DESTINY BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
402 YAUGER WAY SW, OLYMPIA, WA 98502-8660
(360) 878-8248
Mailing address
1294 EBBETS DR SW, TUMWATER, WA 98512-4606
(564) 464-9509
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
01/21/2021
Last updated
02/14/2024
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