Healthcare Provider Details

I. General information

NPI: 1285575415
Provider Name (Legal Business Name): DESTINY BEADLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 N KING ST
HAMPTON VA
23669-1909
US

IV. Provider business mailing address

329 ADWOOD CT
NEWPORT NEWS VA
23605-1448
US

V. Phone/Fax

Practice location:
  • Phone: 757-742-9596
  • Fax:
Mailing address:
  • Phone: 757-742-9596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: