| Transformative Destiny Pllc | |
|
4801 Glenwood Ave Ste 200 Raleigh NC 27612-3857 | |
| (419) 577-0361 | |
| Not Available |
| Full Name | Transformative Destiny Pllc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 4801 Glenwood Ave Ste 200, Raleigh, North Carolina |
| Authorized Official Name and Position | Tiffany Williamson (CEO) |
| Authorized Official Contact | 4195770361 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Transformative Destiny Pllc 208 Callandale Ln Durham NC 27703-9496 Ph: (419) 577-0361 | Transformative Destiny Pllc 4801 Glenwood Ave Ste 200 Raleigh NC 27612-3857 Ph: (419) 577-0361 |
| NPI Number | 1740937895 |
|---|---|
| Provider Enumeration Date | 03/08/2022 |
| Last Update Date | 03/08/2022 |
| Certification Date | 03/08/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740937895 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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