| Destiny Services, Inc | |
|
1124 W Washington St Petersburg VA 23803-3921 | |
| (804) 919-4014 | |
| (804) 863-1695 |
| Full Name | Destiny Services, Inc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1124 W Washington St, Petersburg, Virginia |
| Authorized Official Name and Position | Terrence Augustus Allen (PRESIDENT) |
| Authorized Official Contact | 8049194014 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Destiny Services, Inc 801 Kingsland Rd Richmond VA 23231-8342 Ph: (804) 919-4014 | Destiny Services, Inc 1124 W Washington St Petersburg VA 23803-3921 Ph: (804) 919-4014 |
| NPI Number | 1972838449 |
|---|---|
| Provider Enumeration Date | 10/16/2009 |
| Last Update Date | 10/16/2009 |
| Medicare PECOS PAC ID | 5890184477 |
|---|---|
| Medicare Enrollment ID | O20211122000168 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972838449 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 1322 (Virginia) | Primary |
| Provider Name | Sridhar Yaratha |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1902922503 PECOS PAC ID: 9739110412 Enrollment ID: I20050823000161 |
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