Provider Demographics
NPI:1699511485
Name:ALDERMAN, DESTINY ROSE (CDCA)
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:ROSE
Last Name:ALDERMAN
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29521 KIME HOLDERMAN RD
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-9433
Mailing Address - Country:US
Mailing Address - Phone:740-571-1436
Mailing Address - Fax:
Practice Address - Street 1:327 E MILL ST
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-2029
Practice Address - Country:US
Practice Address - Phone:740-500-1402
Practice Address - Fax:740-500-1718
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.187692101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)