Organization
CREATOR DESTINY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YOLANDA ANNETTE BONNER (OWNER)
(504) 220-8442
Entity
Organization
Contact information
Practice address
503 E LOYOLA DR, KENNER, LA 70065-4119
(504) 220-8442
Mailing address
PO BOX 2353, KENNER, LA 70063-2353
(504) 220-8442
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
4469
LA
101YP2500X
Professional Counselor
Primary
4469
LA
251S00000X
Community/Behavioral Health Agency
4469
LA
305R00000X
Preferred Provider Organization
4469
LA
Other
Enumeration date
01/22/2015
Last updated
03/09/2015
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