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General NPI Number Information
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NPI Number | 1811711856
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Entity Type | Organization
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Legal Business Name | DESTINED BEGINNINGS LLC
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 485 S INDEPENDENCE BLVD STE 115
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-1129
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Country | US
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Telephone | 757-581-1549
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Fax |
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Provider Business Mailing Address
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Address Line | 1305 CONOGA ST
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City | NORFOLK
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State | VA
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Zip | 23523-1993
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Country | US
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Telephone | 757-359-3204
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MISS REGINIQUE K GRIFFIN
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Credential |
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Telephone | 757-359-3204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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