Provider Demographics
NPI:1386136083
Name:WEEMS, DESTINIE CHANTAL (LPC)
Entity type:Individual
Prefix:MRS
First Name:DESTINIE
Middle Name:CHANTAL
Last Name:WEEMS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 COURTHOUSE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-1889
Mailing Address - Country:US
Mailing Address - Phone:228-395-8378
Mailing Address - Fax:228-604-8016
Practice Address - Street 1:370 COURTHOUSE RD STE 102
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-1889
Practice Address - Country:US
Practice Address - Phone:228-395-8378
Practice Address - Fax:228-604-8016
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2142101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional