Organization
DESTINATION LIFE LLC
Active
Parent organization
DESTINATION LIFE LLC
Other names
SaJourney
Organization subpart
Yes
Provider details
NPI number
Legal business name
DESTINATION LIFE LLC
Authorized official
ZEMELDA D. CARR (ADM & AUTH REP)
(817) 473-1312
Entity
Organization
Contact information
Practice address
2001 SE GREEN OAKS BLVD STE 130, ARLINGTON, TX 76018-0952
(817) 473-1312
(866) 990-2813
Mailing address
2001 SE GREEN OAKS BLVD STE 130, ARLINGTON, TX 76018-0952
(817) 473-1312
(866) 990-2813
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
207KI0005X
Clinical & Laboratory Immunology (Allergy & Immunology) Physician
—
—
225X00000X
Occupational Therapist
Primary
—
—
251B00000X
Case Management Agency
—
—
251J00000X
Nursing Care Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
363L00000X
Nurse Practitioner
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
363LW0102X
Women's Health Nurse Practitioner
—
—
364SP0807X
Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
—
—
364SP0809X
Adult Psychiatric/Mental Health Clinical Nurse Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03320311
—
MS
01
—
25D2200016
CLIA
MS
05
—
404951201
—
TX
Enumeration date
05/19/2020
Last updated
03/16/2022
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