Provider Demographics
NPI:1811672322
Name:DESTINY SUPPORTIVE SERVICES
Entity type:Organization
Organization Name:DESTINY SUPPORTIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NONI
Authorized Official - Middle Name:
Authorized Official - Last Name:KENDALL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:856-912-0712
Mailing Address - Street 1:1351 FAIRVIEW BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:DELRAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08075-1475
Mailing Address - Country:US
Mailing Address - Phone:856-912-0712
Mailing Address - Fax:856-245-8388
Practice Address - Street 1:1351 FAIRVIEW BLVD STE A
Practice Address - Street 2:
Practice Address - City:DELRAN
Practice Address - State:NJ
Practice Address - Zip Code:08075-1475
Practice Address - Country:US
Practice Address - Phone:856-912-0712
Practice Address - Fax:856-245-8388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-21
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty