Healthcare Provider Details

I. General information

NPI: 1316268121
Provider Name (Legal Business Name): PREDESTINED FOR PURPOSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 06/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5527 PINE CHASE DR 8
ORLANDO FL
32808-4345
US

IV. Provider business mailing address

PO BOX 616753
ORLANDO FL
32861-6753
US

V. Phone/Fax

Practice location:
  • Phone: 407-285-1249
  • Fax: 407-704-1677
Mailing address:
  • Phone: 407-285-1249
  • Fax: 407-704-1677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. BOBBIE ANN BELL
Title or Position: OWNER
Credential:
Phone: 407-285-1249