Provider Demographics
NPI:1811711856
Name:DESTINED BEGINNINGS LLC
Entity type:Organization
Organization Name:DESTINED BEGINNINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:REGINIQUE
Authorized Official - Middle Name:K
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-359-3204
Mailing Address - Street 1:1305 CONOGA ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23523-1993
Mailing Address - Country:US
Mailing Address - Phone:757-359-3204
Mailing Address - Fax:
Practice Address - Street 1:485 S INDEPENDENCE BLVD STE 115
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1129
Practice Address - Country:US
Practice Address - Phone:757-581-1549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No305R00000XManaged Care OrganizationsPreferred Provider Organization