Provider Demographics
NPI:1548330509
Name:CHAMPION, DESTINY (LMFT)
Entity type:Individual
Prefix:MS
First Name:DESTINY
Middle Name:
Last Name:CHAMPION
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 SPERRY AVE STE 22
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7485
Mailing Address - Country:US
Mailing Address - Phone:805-640-5938
Mailing Address - Fax:805-272-9370
Practice Address - Street 1:2021 SPERRY AVE STE 22
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-7485
Practice Address - Country:US
Practice Address - Phone:805-640-5938
Practice Address - Fax:805-272-9370
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39699106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist