Provider Demographics
NPI:1649627068
Name:EDENS, DESTINI
Entity type:Individual
Prefix:
First Name:DESTINI
Middle Name:
Last Name:EDENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DESTINI
Other - Middle Name:
Other - Last Name:TRIPLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1860 ARMORY RD
Mailing Address - Street 2:
Mailing Address - City:PARKTON
Mailing Address - State:NC
Mailing Address - Zip Code:28371-8436
Mailing Address - Country:US
Mailing Address - Phone:615-717-7115
Mailing Address - Fax:
Practice Address - Street 1:1860 ARMORY RD
Practice Address - Street 2:
Practice Address - City:PARKTON
Practice Address - State:NC
Practice Address - Zip Code:28371
Practice Address - Country:US
Practice Address - Phone:615-717-7115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NCP013618104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker