Provider Demographics
NPI:1952004335
Name:DESTINED PATH COMMUNITY SERVICES
Entity Type:Organization
Organization Name:DESTINED PATH COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCAS
Authorized Official - Phone:252-864-9334
Mailing Address - Street 1:PO BOX 1195
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:NC
Mailing Address - Zip Code:27812-1195
Mailing Address - Country:US
Mailing Address - Phone:252-864-9334
Mailing Address - Fax:252-304-3945
Practice Address - Street 1:201 TYSON ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-1847
Practice Address - Country:US
Practice Address - Phone:252-864-9334
Practice Address - Fax:252-304-3945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health