Provider Demographics
NPI:1306733068
Name:DESTINED2 MAKE IT
Entity type:Organization
Organization Name:DESTINED2 MAKE IT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PEER SUPPORT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DELBERT
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:TOWNSEND
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED
Authorized Official - Phone:704-962-5290
Mailing Address - Street 1:4925 SPRINGVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-6760
Mailing Address - Country:US
Mailing Address - Phone:704-962-5290
Mailing Address - Fax:
Practice Address - Street 1:1427 SOUTH BLVD STE 106
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4200
Practice Address - Country:US
Practice Address - Phone:704-962-5290
Practice Address - Fax:704-962-5290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-23
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No332U00000XSuppliersHome Delivered Meals