Provider Demographics
NPI:1780314104
Name:TOWNER, DESTINYE AMANDALEI
Entity type:Individual
Prefix:MRS
First Name:DESTINYE
Middle Name:AMANDALEI
Last Name:TOWNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DESTINYE
Other - Middle Name:
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:625 WHITNEY RANCH DR APT 511
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2647
Mailing Address - Country:US
Mailing Address - Phone:619-647-7964
Mailing Address - Fax:
Practice Address - Street 1:625 WHITNEY RANCH DR APT 511
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2647
Practice Address - Country:US
Practice Address - Phone:619-647-7964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty