Provider Demographics
NPI:1609690080
Name:YOUR DESTINY AWAITS, LLC
Entity type:Organization
Organization Name:YOUR DESTINY AWAITS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:SHALONDRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TURK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-285-7353
Mailing Address - Street 1:5829 CAMPBELLTON RD SW STE 104-213
Mailing Address - Street 2:
Mailing Address - City:SOUTH FULTON
Mailing Address - State:GA
Mailing Address - Zip Code:30331-8037
Mailing Address - Country:US
Mailing Address - Phone:470-285-1779
Mailing Address - Fax:
Practice Address - Street 1:5829 CAMPBELLTON RD SW STE 104-213
Practice Address - Street 2:
Practice Address - City:SOUTH FULTON
Practice Address - State:GA
Practice Address - Zip Code:30331-8037
Practice Address - Country:US
Practice Address - Phone:470-285-1779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)