Provider Demographics
NPI:1639948987
Name:DESIGN DESTINATION YOUTH AND FAMILY NETWORK,LLC
Entity Type:Organization
Organization Name:DESIGN DESTINATION YOUTH AND FAMILY NETWORK,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATOSHA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:STANLEY-BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-850-3025
Mailing Address - Street 1:637 WELSH PL
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5722
Mailing Address - Country:US
Mailing Address - Phone:910-850-3025
Mailing Address - Fax:
Practice Address - Street 1:924 CHESTER CIR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4207
Practice Address - Country:US
Practice Address - Phone:910-850-3025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-28
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health