Provider Demographics
NPI:1659062065
Name:KRUZEL, DESTINY MARIE
Entity Type:Individual
Prefix:
First Name:DESTINY
Middle Name:MARIE
Last Name:KRUZEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2570 POPLAR LN
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-4791
Mailing Address - Country:US
Mailing Address - Phone:770-314-9524
Mailing Address - Fax:
Practice Address - Street 1:6742 JAMESTOWN DR
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3030
Practice Address - Country:US
Practice Address - Phone:770-406-6066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health