MEDICARE: DESTINY CONNECTIONS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	251S00000X	Community/Behavioral Health Agency
3	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1750011730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESTINY CONNECTIONS LLC

Provider Business Mailing Address
First Line	:	9022 COLUMBIA AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44108-2904
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9022 COLUMBIA AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44108-2904
Country	:	US
Telephone Number	:	216-372-6812
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. MIRRIAM KNIGHT
Credential	:	PSYD
Telephone Number	:	216-372-6812

Provider Enumeration Date	:	06/13/2022
Last Update Date	:	06/13/2022

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