Provider Demographics
NPI:1780050716
Name:DESTINY MANAGEMENT INCORPORATED
Entity type:Organization
Organization Name:DESTINY MANAGEMENT INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DAY SUPPORTS COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:BAQP
Authorized Official - Phone:828-391-8282
Mailing Address - Street 1:PO BOX 537
Mailing Address - Street 2:
Mailing Address - City:DREXEL
Mailing Address - State:NC
Mailing Address - Zip Code:28619-0537
Mailing Address - Country:US
Mailing Address - Phone:828-391-8282
Mailing Address - Fax:828-391-8288
Practice Address - Street 1:1056 3RD AVENUE DR NW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-4855
Practice Address - Country:US
Practice Address - Phone:828-855-1807
Practice Address - Fax:828-855-1815
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DESTINY MANAGEMENT INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-13
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-018-090251C00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services