Provider Demographics
NPI:1518729474
Name:DESTINY LIFE SOLUTION, LLC
Entity Type:Organization
Organization Name:DESTINY LIFE SOLUTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BIMBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-510-7817
Mailing Address - Street 1:3A NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-1123
Mailing Address - Country:US
Mailing Address - Phone:609-510-7817
Mailing Address - Fax:
Practice Address - Street 1:3A NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-1123
Practice Address - Country:US
Practice Address - Phone:609-510-7817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health