Provider Demographics
NPI:1922775998
Name:MCCOY, DESTINY MONIQUE AKUA (LMT LE)
Entity Type:Individual
Prefix:
First Name:DESTINY
Middle Name:MONIQUE AKUA
Last Name:MCCOY
Suffix:
Gender:F
Credentials:LMT LE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1049 MAILWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-7437
Mailing Address - Country:US
Mailing Address - Phone:984-900-9926
Mailing Address - Fax:
Practice Address - Street 1:7361 SIX FORKS RD STE 116
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6162
Practice Address - Country:US
Practice Address - Phone:984-900-9926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15335225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty