Most Relevant Information
Provider Data
| NPI Number: | 1003565243 |
| Provider Name: | DESTINY MANWELL |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/23/2022 |
| Last Updated: | 03/23/2022 |
Provider Practice Location
1360 PORTER ST
DEARBORN
MI
481242890
Practice Location Phone/Fax
| Phone: | 3136895188 |
| Fax: |
Provider Mailing Location
1360 PORTER ST
DEARBORN
MI
481242890
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |