Organization · NPI-2

Destiny & Miracle LLC

Community/Behavioral Health · Gastonia, NC

NPI number1801409859

StatusActive

Last updated in NPPESJul 8, 2021

Details

NPI: 1801409859
Entity type: Organization (NPI-2)
Legal business name: Destiny & Miracle LLC
Organization subpart: No
Enumeration date: Aug 28, 2020
Certification date: Jul 8, 2021
Last updated: Jul 8, 2021

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
251S00000X	Community/Behavioral Health	–	–	Yes
101YA0400X	Counselor, Addiction (Substance Use Disorder)	–	–
101YM0800X	Counselor, Mental Health	–	–
106S00000X	Behavior Technician	–	–
175T00000X	Peer Specialist	–	–
251B00000X	Case Management	–	–
253Z00000X	In Home Supportive Care	–	–
347C00000X	Private Vehicle	–	–
374U00000X	Home Health Aide	–	–

Practice location

2551 Pembroke Rd
Gastonia, NC 28054-4712

Phone 678-545-7340 · Fax 704-691-7044

Mailing address

2551 Pembroke Rd
Gastonia, NC 28054-4712

Phone 678-545-7340 · Fax 704-691-7044

Authorized official

Antoinette Steele
Ceo/Executive Director
6785457340

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