Healthcare Provider Details

I. General information

NPI: 1588521793
Provider Name (Legal Business Name): MY LIFE SPEAKS COUNSELING AND COACHING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1129 SHOAL CREEK TRAIL
CHESAPEAKE VA
23320
US

IV. Provider business mailing address

1021 EDEN WAY N STE 118
CHESAPEAKE VA
23320-2776
US

V. Phone/Fax

Practice location:
  • Phone: 609-804-8771
  • Fax:
Mailing address:
  • Phone: 609-804-8771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MISS STEPHANIE DENISE BRADLEY-BLUE
Title or Position: CEO
Credential: LPC
Phone: 609-496-3398