=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215211420
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE CENTER OF DESTINY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2011
-----------------------------------------------------
Last Update Date | 10/06/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7027 MILLERS GLEN WAY
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38125-4184
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-496-1146
-----------------------------------------------------
Fax | 888-355-7312
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7027 MILLERS GLEN WAY
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38125-4184
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-496-1146
-----------------------------------------------------
Fax | 888-355-7312
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT & EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MRS. TAMMY WIGGINS WINSTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 901-496-1146
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251V00000X
-----------------------------------------------------
Taxonomy Name | Voluntary or Charitable Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------