Healthcare Provider Details

I. General information

NPI: 1306733068
Provider Name (Legal Business Name): DESTINED 2 MAKE IT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3117 WHITING AVE
CHARLOTTE NC
28205-1648
US

IV. Provider business mailing address

3117 WHITING AVE
CHARLOTTE NC
28205-1648
US

V. Phone/Fax

Practice location:
  • Phone: 704-962-5290
  • Fax: 336-900-1666
Mailing address:
  • Phone: 704-962-5290
  • Fax: 336-900-1666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DELBERT ALEXANDER TOWNSEND
Title or Position: PEER SUPPORT SPECIALIST
Credential: CERTIFIED
Phone: 704-962-5290