Healthcare Provider Details

I. General information

NPI: 1821227489
Provider Name (Legal Business Name): NEW DESTINATIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2009
Last Update Date: 06/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 SOUTHWOOD DR
DURHAM NC
27707-2114
US

IV. Provider business mailing address

5720 TURNER STORE LN
RALEIGH NC
27603-7976
US

V. Phone/Fax

Practice location:
  • Phone: 919-493-9051
  • Fax: 919-490-1347
Mailing address:
  • Phone: 828-572-2024
  • Fax: 980-225-0385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL-032-499
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNC

VIII. Authorized Official

Name: MR. LARRY LEE LACKEY
Title or Position: DIRECTOR/EXECUTIVE DIRECTOR
Credential:
Phone: 919-414-2860