| Destilee Llc | |
|
6104 Whittemore Ct Upper Marlboro MD 20772-4155 | |
| (443) 244-7615 | |
| Not Available |
| Full Name | Destilee Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 6104 Whittemore Ct, Upper Marlboro, Maryland |
| Authorized Official Name and Position | Vanessa Chappell Lee (OWNER) |
| Authorized Official Contact | 4432447615 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Destilee Llc 6104 Whittemore Ct Upper Marlboro MD 20772-4155 Ph: (443) 244-7615 | Destilee Llc 6104 Whittemore Ct Upper Marlboro MD 20772-4155 Ph: (443) 244-7615 |
| NPI Number | 1083081335 |
|---|---|
| Provider Enumeration Date | 08/21/2015 |
| Last Update Date | 08/21/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083081335 | NPI | - | NPPES |
| 12530000 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 643495 (Maryland) | Primary |
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