Healthcare Provider Details

I. General information

NPI: 1821912106
Provider Name (Legal Business Name): DESTINY FULFILLED COMMUNITY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 GILDAY CT
NORTH LAS VEGAS NV
89030-4059
US

IV. Provider business mailing address

618 GILDAY CT
NORTH LAS VEGAS NV
89030-4059
US

V. Phone/Fax

Practice location:
  • Phone: 702-969-8762
  • Fax:
Mailing address:
  • Phone: 310-486-1354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. MARILYNN TOWNER
Title or Position: OWNER
Credential: MA, LADC
Phone: 310-486-1354