Provider Demographics
NPI:1518568427
Name:SEGOVIA, DESTINY (CT)
Entity Type:Individual
Prefix:
First Name:DESTINY
Middle Name:
Last Name:SEGOVIA
Suffix:
Gender:F
Credentials:CT
Other - Prefix:
Other - First Name:DESTINY
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:94 CROSSING PL
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43031-9499
Mailing Address - Country:US
Mailing Address - Phone:443-716-5488
Mailing Address - Fax:
Practice Address - Street 1:4041 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3247
Practice Address - Country:US
Practice Address - Phone:614-245-2555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor