Individual
DESTINY MARIELLE IRVING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
424 S EXTENSION ST, HAZLEHURST, MS 39083-3312
(601) 988-7723
Mailing address
3500 JOHN A MERRITT BLVD # 6734, NASHVILLE, TN 37209-1500
(601) 988-7723
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
08/14/2024
Last updated
08/14/2024
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