Destiny Sober Living

LBN: Destiny Sober Living
Destiny Sober Living is an health care organization with primary practice located at 5306 N 17Th Ave , Phoenix AZ 85015-3035. The organization recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) is the primary health care specialty. Destiny Sober Living can be contacted via phone (602) 249-6674, or through Bynum, Kathleen via phone (602) 249-6674.

Contact Information

Primary practice address
5306 N 17Th Ave Phoenix AZ 85015-3035
Phone: (602) 249-6674
Fax: (602) 926-0590
Website:
Map and Directions
Authorized official contact:
Name: Bynum, Kathleen Licensed Professional Counselor (LPC)
Phone: (602) 249-6674

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X BH3285 Arizona
Behavioral Health & Social Service Providers / Mental Health 101YM0800X BH3285 Arizona
Behavioral Health & Social Service Providers / Professional 101YP2500X Arizona

Profile Details

NPI number 1104365287
LBN Legal business name Destiny Sober Living
DBA Doing business as
Authorized official Bynum, Kathleen Licensed Professional Counselor (LPC)
Entity Organization
Organization subpart 1 No
Enumeration date Feb 22nd, 2017
Last updated Feb 22nd, 2017 - about 9 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104365287 NPPES
Arizona MEDICAID 439095
Arizona MEDICAID 148801
Arizona MEDICAID 925164

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