Organization
NEW DESTINATON LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES WESTLY AVERYT LICSW (CLINICAL DIRECTOR)
(202) 546-0000
Entity
Organization
Contact information
Practice address
1424 PENNSYLVANIA AVE SE, WASHINGTON, DC 20003-3029
(202) 546-0000
Mailing address
1424 PENNSYLVANIA AVE SE, WASHINGTON, DC 20003-3029
(202) 546-0000
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
02/08/2008
Last updated
04/23/2009
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