Provider Demographics
NPI:1154972370
Name:O'HAGAN, DESTINY AUGUSTINA
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:AUGUSTINA
Last Name:O'HAGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DESTINY
Other - Middle Name:AUGUSTINA
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11262 SANDY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-7081
Mailing Address - Country:US
Mailing Address - Phone:302-841-9897
Mailing Address - Fax:
Practice Address - Street 1:11262 SANDY RIDGE DR
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-7081
Practice Address - Country:US
Practice Address - Phone:302-841-9897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-28
Last Update Date:2019-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician