Organization
DESTINI THERAPEUTIC SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER MANGUM (CEO)
(434) 575-0855
Entity
Organization
Contact information
Practice address
3152 HALIFAX RD STE E, SOUTH BOSTON, VA 24592-4906
(434) 575-0855
(434) 207-6164
Mailing address
3152-E HALIFAX ROAD, E, SOUTH BOSTON, VA 24592-4906
(434) 575-0855
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
103TC1900X
Counseling Psychologist
—
—
2084P0800X
Psychiatry Physician
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
10/30/2010
Last updated
02/14/2014
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