Provider Demographics
NPI:1306438171
Name:HORNE, DESTINEE LARHEA
Entity type:Individual
Prefix:MS
First Name:DESTINEE
Middle Name:LARHEA
Last Name:HORNE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:DESTINEE
Other - Middle Name:LARHEA
Other - Last Name:HORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:148 MCDOWELL ST
Mailing Address - Street 2:
Mailing Address - City:WELCH
Mailing Address - State:WV
Mailing Address - Zip Code:24801-2225
Mailing Address - Country:US
Mailing Address - Phone:304-436-6800
Mailing Address - Fax:304-436-6803
Practice Address - Street 1:148 MCDOWELL ST
Practice Address - Street 2:
Practice Address - City:WELCH
Practice Address - State:WV
Practice Address - Zip Code:24801-2225
Practice Address - Country:US
Practice Address - Phone:304-436-6800
Practice Address - Fax:304-436-6803
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator