Destilee LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

643495 Issued in MD

Legal business name

DESTILEE LLC

Doing business as

Destilee Health Care

Practice address

6104 Whittemore CT
Upper Marlboro, MD 20772-4155

Phone

(443) 244-7615

NPI assigned

Aug 21, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Vanessa Chappell Lee, PH.D.

Title

Owner

Phone

(443) 244-7615

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Destilee Health Care Doing business as

Tax ID family

Destilee Health Care3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Destilee Consulting LLC

  dba Destilee Health Care

  • Clinical Social Worker
  • Sykesville, MD
  • NPI 1073788725
  NPD tax ID
• Destilee Health Care

  • Clinical Social Worker
  • Randallstown, MD
  • NPI 1457582900
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1440115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440115200000",
    "number": "1083081335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6104 WHITTEMORE CT",
            "city": "UPPER MARLBORO",
            "state": "MD",
            "postal_code": "207724155",
            "telephone_number": "443-244-7615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6104 WHITTEMORE CT",
            "city": "UPPER MARLBORO",
            "state": "MD",
            "postal_code": "207724155",
            "telephone_number": "443-244-7615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESTILEE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-21",
        "last_updated": "2015-08-21",
        "status": "A",
        "authorized_official_last_name": "CHAPPELL LEE",
        "authorized_official_first_name": "VANESSA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "443-244-7615",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "643495",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12530000",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Destilee Health Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dewis Healthcare LLC
• Kristen Lynne Deyoung
• Aicha Diaby
• Mohamed Lanfia Diaby

• Clinical Social Worker in Upper Marlboro, MD
• Providers in Upper Marlboro, MD by specialty
• Clinical Social Worker in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.