Provider Demographics
NPI:1972278430
Name:RIPLEY, DESTINY
Entity Type:Individual
Prefix:
First Name:DESTINY
Middle Name:
Last Name:RIPLEY
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 1:591 STEWART WAY
Mailing Address - Street 2:
Mailing Address - City:RIO VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:94571-1290
Mailing Address - Country:US
Mailing Address - Phone:707-301-6261
Mailing Address - Fax:
Practice Address - Street 1:1234 EMPIRE ST # 1500
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5711
Practice Address - Country:US
Practice Address - Phone:707-426-4746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2024-03-06
Deactivation Date:2022-06-21
Deactivation Code:
Reactivation Date:2022-08-30
Provider Licenses
StateLicense IDTaxonomies
CA120949104100000X
101YM0800X, 225400000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner