Provider Demographics
NPI:1568207744
Name:KETCHENS, DESTINI ALMA (DSW, LCSW)
Entity type:Individual
Prefix:DR
First Name:DESTINI
Middle Name:ALMA
Last Name:KETCHENS
Suffix:
Gender:F
Credentials:DSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10432 BELL RINGER WAY
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46235-2107
Mailing Address - Country:US
Mailing Address - Phone:312-371-8262
Mailing Address - Fax:
Practice Address - Street 1:10432 BELL RINGER WAY
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46235-2107
Practice Address - Country:US
Practice Address - Phone:312-371-8262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-28
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34011583A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical