Provider Demographics
NPI:1922751742
Name:DESTINY SUPPORT COORDINATORS, INC
Entity Type:Organization
Organization Name:DESTINY SUPPORT COORDINATORS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PART OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-259-3918
Mailing Address - Street 1:319 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2617
Mailing Address - Country:US
Mailing Address - Phone:850-654-2095
Mailing Address - Fax:
Practice Address - Street 1:319 CYPRESS ST
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2617
Practice Address - Country:US
Practice Address - Phone:850-654-2095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty