Provider Demographics
NPI:1164613444
Name:DESTINY MANAGEMENT INCORPORATED
Entity Type:Organization
Organization Name:DESTINY MANAGEMENT INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:828-994-2645
Mailing Address - Street 1:2061 WALL ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-8383
Mailing Address - Country:US
Mailing Address - Phone:828-994-2645
Mailing Address - Fax:828-221-0988
Practice Address - Street 1:1460 US 70 W
Practice Address - Street 2:
Practice Address - City:VALDESE
Practice Address - State:NC
Practice Address - Zip Code:28690-9593
Practice Address - Country:US
Practice Address - Phone:828-994-2645
Practice Address - Fax:828-221-0988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6005972251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005972Medicaid