Healthcare Provider Details

I. General information

NPI: 1750156923
Provider Name (Legal Business Name): DESTINY PSYCHIATRY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2023
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 FORBES BLVD STE 200
LANHAM MD
20706-6316
US

IV. Provider business mailing address

4500 FORBES BLVD STE 200
LANHAM MD
20706-6316
US

V. Phone/Fax

Practice location:
  • Phone: 301-778-6739
  • Fax:
Mailing address:
  • Phone: 301-778-6739
  • 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

VIII. Authorized Official

Name: YVONNE MBA
Title or Position: PROVIDER
Credential:
Phone: 301-778-6739