Provider Demographics
NPI:1811222714
Name:FLOYD, DESTINEE (LCSW)
Entity Type:Individual
Prefix:
First Name:DESTINEE
Middle Name:
Last Name:FLOYD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7707 CANFORD ST
Mailing Address - Street 2:#H
Mailing Address - City:CAMBY
Mailing Address - State:IN
Mailing Address - Zip Code:46113-8291
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7707 CANFORD ST
Practice Address - Street 2:#H
Practice Address - City:CAMBY
Practice Address - State:IN
Practice Address - Zip Code:46113-8291
Practice Address - Country:US
Practice Address - Phone:863-860-1621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-09
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
IN34006609A101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100270530AMedicaid
IN100270530AMedicaid