Healthcare Provider Details

I. General information

NPI: 1043096555
Provider Name (Legal Business Name): DESTINED 4 GREATNESS BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 W PENNSYLVANIA AVE STE 309A
TOWSON MD
21204-5009
US

IV. Provider business mailing address

22 W PENNSYLVANIA AVE STE 309A
TOWSON MD
21204-5009
US

V. Phone/Fax

Practice location:
  • Phone: 443-898-2620
  • Fax:
Mailing address:
  • Phone: 443-898-2620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MR. RONALD E SATTERFIELD JR.
Title or Position: OWNER
Credential: LMSW, LCADC
Phone: 443-454-5972