MEDICARE: DESTINED FOR A CHANGE, INC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1821944315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESTINED FOR A CHANGE, INC

Provider Business Mailing Address
First Line	:	2968 GENERAL COLLINS AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70114-6859
Country	:	US
Telephone Number	:	504-766-7098
Fax Number	:	504-459-2145

Provider Business Practice Location Address
First Line	:	2968 GENERAL COLLINS AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70114-6859
Country	:	US
Telephone Number	:	504-766-7098
Fax Number	:	504-459-2145

Authorized Official
Title or Position	:	DIRECTOR
Name	:	NEDDESHA STALKS
Credential	:
Telephone Number	:	504-766-7098

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	03/06/2026

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