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General NPI Number Information
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NPI Number | 1982367801
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Entity Type | Organization
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Legal Business Name | DESTINED FOR BRIGHTER FUTURES FOUNDATION LLC
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Dates
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Enumeration Date | 10/18/2021
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Last Update Date | 02/07/2024
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Provider Practice Location Address
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Address Line | 900 COMMONWEALTH PL STE 225
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-4517
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Country | US
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Telephone | 757-239-9125
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Fax |
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Provider Business Mailing Address
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Address Line | 900 COMMONWEALTH PL STE 225
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-4517
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Country | US
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Telephone | 757-239-9125
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. DAVIDA FALTZ
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Credential |
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Telephone | 757-239-9125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 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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