Provider Demographics
NPI:1457582900
Name:DESTILEE HEALTH CARE
Entity Type:Organization
Organization Name:DESTILEE HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAPPELL-LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-496-5444
Mailing Address - Street 1:9006 LIBERTY RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-3931
Mailing Address - Country:US
Mailing Address - Phone:410-496-5444
Mailing Address - Fax:443-303-4320
Practice Address - Street 1:9006 LIBERTY RD
Practice Address - Street 2:SUITE 2
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-3931
Practice Address - Country:US
Practice Address - Phone:410-496-5444
Practice Address - Fax:443-303-4320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD118971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty