Provider Demographics
NPI:1215100854
Name:DAUGHTER OF DESTINY ENTERPRISES,LLC
Entity type:Organization
Organization Name:DAUGHTER OF DESTINY ENTERPRISES,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:HERLENE
Authorized Official - Last Name:CARMACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-661-1792
Mailing Address - Street 1:941 US HIGHWAY 64 E
Mailing Address - Street 2:1672 LONG RIDGE RD
Mailing Address - City:PLYMOUTH
Mailing Address - State:NC
Mailing Address - Zip Code:27962-9216
Mailing Address - Country:US
Mailing Address - Phone:252-661-1792
Mailing Address - Fax:252-793-5022
Practice Address - Street 1:941 US HIGHWAY 64 E
Practice Address - Street 2:1672 LONG RIDGE RD
Practice Address - City:PLYMOUTH
Practice Address - State:NC
Practice Address - Zip Code:27962-9216
Practice Address - Country:US
Practice Address - Phone:252-661-1792
Practice Address - Fax:252-793-5022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health