Provider Demographics
NPI:1851722532
Name:DESTINATION GREATNESS, LLC
Entity Type:Organization
Organization Name:DESTINATION GREATNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNA
Authorized Official - Middle Name:A
Authorized Official - Last Name:JEFFERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, CFSW, LCSW
Authorized Official - Phone:919-794-5284
Mailing Address - Street 1:PO BOX 13273
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27709-3273
Mailing Address - Country:US
Mailing Address - Phone:919-794-5284
Mailing Address - Fax:
Practice Address - Street 1:1142 FLAT ST E
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:SC
Practice Address - Zip Code:29810-5818
Practice Address - Country:US
Practice Address - Phone:919-794-5284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DESTINATION GREATNESS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-06
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty