Healthcare Provider Details

I. General information

NPI: 1023722485
Provider Name (Legal Business Name): DESTINED INSPIRATIONS COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2023
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5557 BALTIMORE AVE STE 500-939
HYATTSVILLE MD
20781-1922
US

IV. Provider business mailing address

5557 BALTIMORE AVE STE 500-939
HYATTSVILLE MD
20781-1922
US

V. Phone/Fax

Practice location:
  • Phone: 240-853-2837
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHANAY WILLIAMS PAYNE
Title or Position: CLINICAL SOCIAL WORKER
Credential: LCSW-C, LICSW
Phone: 240-853-2837