Individual
DESTINI EDENS
Active
Individual
DESTINI EDENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
P013618
NC
1041C0700X
Clinical Social Worker
Primary
P013618
NC
Other
Enumeration date
05/16/2016
Last updated
10/21/2019
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