Provider Demographics
NPI:1710527833
Name:DUST TO DESTINY COUNSELING & WELLNESS LLC
Entity Type:Organization
Organization Name:DUST TO DESTINY COUNSELING & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CORNISH
Authorized Official - Suffix:
Authorized Official - Credentials:BEHAVIORAL HEALTH
Authorized Official - Phone:804-305-5868
Mailing Address - Street 1:9937 GREYWELL TER
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-3676
Mailing Address - Country:US
Mailing Address - Phone:804-305-5838
Mailing Address - Fax:703-799-3661
Practice Address - Street 1:9937 GREYWELL TER
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-3676
Practice Address - Country:US
Practice Address - Phone:804-305-5838
Practice Address - Fax:703-799-3661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty