| Journey To Your Destiny, Pllc | |
|
2404 Sandy River Lane Apt 103 Charlotte NC 28273 | |
| (910) 431-6163 | |
| (704) 327-5547 |
| Full Name | Journey To Your Destiny, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 2404 Sandy River Lane Apt 103, Charlotte, North Carolina |
| Authorized Official Name and Position | Donnetta L Evans (PSYCHOTHERAPIST/ CEO) |
| Authorized Official Contact | 9104316163 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Journey To Your Destiny, Pllc 6241 South Blvd Unit 241883 Charlotte NC 28224-0327 Ph: (704) 430-5547 | Journey To Your Destiny, Pllc 2404 Sandy River Lane Apt 103 Charlotte NC 28273 Ph: (910) 431-6163 |
| NPI Number | 1578223954 |
|---|---|
| Provider Enumeration Date | 12/27/2021 |
| Last Update Date | 02/09/2022 |
| Certification Date | 02/09/2022 |
| Medicare PECOS PAC ID | 8820483696 |
|---|---|
| Medicare Enrollment ID | O20220314000480 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578223954 | NPI | - | NPPES |
| 1932514601 | Medicaid | NC | |
| 1578223954 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Donnetta Lafaye Evans |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932514601 PECOS PAC ID: 5496185456 Enrollment ID: I20200415003103 |
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