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General NPI Number Information
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NPI Number | 1215100854
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Entity Type | Organization
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Legal Business Name | DAUGHTER OF DESTINY ENTERPRISES,LLC
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Dates
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Enumeration Date | 04/03/2008
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Last Update Date | 04/03/2008
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Provider Practice Location Address
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Address Line | 941 US HIGHWAY 64 E 1672 LONG RIDGE RD
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City | PLYMOUTH
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State | NC
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Zip | 27962-9216
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Country | US
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Telephone | 252-661-1792
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Fax | 252-793-5022
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Provider Business Mailing Address
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Address Line | 941 US HIGHWAY 64 E 1672 LONG RIDGE RD
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City | PLYMOUTH
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State | NC
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Zip | 27962-9216
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Country | US
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Telephone | 252-661-1792
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Fax | 252-793-5022
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Authorized Official
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Title or Position | CEO
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Name | MS. JENNIFER HERLENE CARMACK
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Credential |
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Telephone | 252-661-1792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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