MEDICARE: YOUR DESTINY AWAITS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1609690080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUR DESTINY AWAITS, LLC

Provider Business Mailing Address
First Line	:	5829 CAMPBELLTON RD SW STE 104-213
Second Line	:
City	:	SOUTH FULTON
State	:	GA
Zip	:	30331-8037
Country	:	US
Telephone Number	:	470-285-1779
Fax Number	:

Provider Business Practice Location Address
First Line	:	5829 CAMPBELLTON RD SW STE 104-213
Second Line	:
City	:	SOUTH FULTON
State	:	GA
Zip	:	30331-8037
Country	:	US
Telephone Number	:	470-285-1779
Fax Number	:

Authorized Official
Title or Position	:	SOCIAL WORKER
Name	:	SHALONDRIA TURK
Credential	:
Telephone Number	:	404-285-7353

Provider Enumeration Date	:	11/12/2024
Last Update Date	:	11/12/2024

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