Transformative Destiny PLLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

TRANSFORMATIVE DESTINY PLLC

Practice address

4801 Glenwood Ave Ste 200
Raleigh, NC 27612-3857

Phone

(419) 577-0361

NPI assigned

Mar 8, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tiffany Williamson, MEDNPI 1750038899

Title

Ceo

Phone

(419) 577-0361

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tiffany Williamson

  • Mental Health Counselor
  • Raleigh, NC
  • NPI 1750038899
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1646697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646697600000",
    "number": "1740937895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 CALLANDALE LN",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277039496",
            "telephone_number": "419-577-0361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 GLENWOOD AVE STE 200",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276123857",
            "telephone_number": "419-577-0361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRANSFORMATIVE DESTINY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-08",
        "last_updated": "2022-03-08",
        "certification_date": "2022-03-08",
        "status": "A",
        "authorized_official_last_name": "WILLIAMSON",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "419-577-0361",
        "authorized_official_credential": "MED"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.