Individual
DESTINY GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1010 N HANCOCK ST, PHILADELPHIA, PA 19123-2334
(000) 000-0000
Mailing address
2332 W CUMBERLAND ST, PHILADELPHIA, PA 19132-4118
(267) 707-7374
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
12/01/2022
Last updated
12/01/2022
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