Individual
DESTINY GWANULLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9407 SPRING HOUSE LN APT A, LAUREL, MD 20708-3294
(443) 941-5965
Mailing address
9407 SPRING HOUSE LN APT A, LAUREL, MD 20708-3294
(443) 941-5965
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
09/06/2023
Last updated
09/06/2023
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