| Destined 2 Thrive Llc | |
|
1930 Harcourt Cir Apt 103 Fayetteville NC 28304-0585 | |
| (757) 339-9193 | |
| Not Available |
| Full Name | Destined 2 Thrive Llc |
|---|---|
| Speciality | Counselor |
| Location | 1930 Harcourt Cir Apt 103, Fayetteville, North Carolina |
| Authorized Official Name and Position | Charmaine James (AUTHORIZED AGENT) |
| Authorized Official Contact | 7573399193 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Destined 2 Thrive Llc 1930 Harcourt Cir Apt 103 Fayetteville NC 28304-0585 Ph: (757) 339-9193 | Destined 2 Thrive Llc 1930 Harcourt Cir Apt 103 Fayetteville NC 28304-0585 Ph: (757) 339-9193 |
| NPI Number | 1255906806 |
|---|---|
| Provider Enumeration Date | 05/26/2021 |
| Last Update Date | 12/29/2021 |
| Certification Date | 12/29/2021 |
| Medicare PECOS PAC ID | 2769919836 |
|---|---|
| Medicare Enrollment ID | O20241231002603 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255906806 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Charmaine Nicole James |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1487128013 PECOS PAC ID: 3678000742 Enrollment ID: I20241231002749 |
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