Provider Demographics
NPI:1497030928
Name:DESTINY ADULT, CHILD & FAMILY SERVICES LLC
Entity Type:Organization
Organization Name:DESTINY ADULT, CHILD & FAMILY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-202-3595
Mailing Address - Street 1:701 DISHMAN LANE EXT STE 3
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-4033
Mailing Address - Country:US
Mailing Address - Phone:270-495-1609
Mailing Address - Fax:270-599-0399
Practice Address - Street 1:701 DISHMAN LANE EXT STE 3
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-4033
Practice Address - Country:US
Practice Address - Phone:270-495-1609
Practice Address - Fax:270-599-0399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-16
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health