| Destination Greatness, Pllc | |
|
2530 Meridian Pkwy Ste 300 Durham NC 27713-5273 | |
| (919) 794-5284 | |
| (866) 923-0754 |
| Full Name | Destination Greatness, Pllc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2530 Meridian Pkwy Ste 300, Durham, North Carolina |
| Authorized Official Name and Position | Shanna Amanda Jefferson (CEO) |
| Authorized Official Contact | 9197945284 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Destination Greatness, Pllc 2530 Meridian Pkwy Ste 300 Durham NC 27713-5273 Ph: (919) 794-5284 | Destination Greatness, Pllc 2530 Meridian Pkwy Ste 300 Durham NC 27713-5273 Ph: (919) 794-5284 |
| NPI Number | 1215374228 |
|---|---|
| Provider Enumeration Date | 05/30/2013 |
| Last Update Date | 02/10/2021 |
| Certification Date | 02/10/2021 |
| Medicare PECOS PAC ID | 3971743048 |
|---|---|
| Medicare Enrollment ID | O20130712000695 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215374228 | NPI | - | NPPES |
| 1215374228 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Shanna Jefferson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093012031 PECOS PAC ID: 4880834951 Enrollment ID: I20130712000700 |
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