Provider Demographics
NPI:1649995804
Name:MY LIFE HAS DESTINY CONSULTING AND BILLING SERVICES LLC
Entity type:Organization
Organization Name:MY LIFE HAS DESTINY CONSULTING AND BILLING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:AQUINTAS
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-557-5908
Mailing Address - Street 1:PO BOX 3237
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-3237
Mailing Address - Country:US
Mailing Address - Phone:678-557-5908
Mailing Address - Fax:804-203-1657
Practice Address - Street 1:3131 S CRATER RD STE 3237
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9218
Practice Address - Country:US
Practice Address - Phone:678-557-5908
Practice Address - Fax:804-203-1657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty