Provider Demographics
NPI:1144754318
Name:COMMINIE, DESTANI
Entity type:Individual
Prefix:
First Name:DESTANI
Middle Name:
Last Name:COMMINIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:487 CASTLE DR.
Mailing Address - Street 2:
Mailing Address - City:LAPLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70049
Mailing Address - Country:US
Mailing Address - Phone:504-756-0095
Mailing Address - Fax:
Practice Address - Street 1:487 CASTLE DR.
Practice Address - Street 2:
Practice Address - City:EDGARD
Practice Address - State:LA
Practice Address - Zip Code:70049
Practice Address - Country:US
Practice Address - Phone:504-756-0095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health