Provider Demographics
NPI:1245821826
Name:DESTINED PACE COUNSELING & CONSULTING, LLC
Entity type:Organization
Organization Name:DESTINED PACE COUNSELING & CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED PROFESSIONAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:KAISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:540-400-1192
Mailing Address - Street 1:6870 WOODCREEPER DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-3816
Mailing Address - Country:US
Mailing Address - Phone:540-400-1192
Mailing Address - Fax:
Practice Address - Street 1:3524 BRAMBLETON AVE STE 2
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-6528
Practice Address - Country:US
Practice Address - Phone:540-400-1192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty