Individual
DESTINY WINELAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2420 LINWOOD DR STE 1&2, PARAGOULD, AR 72450-6122
(870) 236-5880
(870) 236-5757
Mailing address
1707 LINWOOD DR STE G, PARAGOULD, AR 72450-5365
(866) 972-1268
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6944-C
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
228492719
—
AR
Enumeration date
11/11/2011
Last updated
08/23/2021
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