Organization Name: | DESTILEE LLC |
NPI Number: | 1083081335 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | VANESSA CHAPPELL LEE (OWNER) |
Mailing Address: | 6104 Whittemore Ct Upper Marlboro |
State: | MD US |
Postal Code: | 207724155 |
Phone Number: | 4432447615 |
Fax Number: | |
NPI Enumeration Date: | 08/21/2015 |
NPI Last Update Date: | 08/21/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 643495 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |