Provider Demographics
NPI:1073360459
Name:HOUSE, DESTINEY
Entity type:Individual
Prefix:
First Name:DESTINEY
Middle Name:
Last Name:HOUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17381 NW 7TH AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-7086
Mailing Address - Country:US
Mailing Address - Phone:239-204-6806
Mailing Address - Fax:
Practice Address - Street 1:17381 NW 7TH AVE APT 101
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-7086
Practice Address - Country:US
Practice Address - Phone:239-204-6806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker