Individual
DESTINY NORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA
Contact information
Practice address
904 M L KING DR, CENTRALIA, IL 62801-3058
(618) 553-1391
Mailing address
904 M L KING DR, CENTRALIA, IL 62801-3058
(618) 553-1391
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
03/02/2016
Last updated
03/02/2016
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