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? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |