# DESTINY'S FULFILLED INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831254119
- **Authorized official:** MISS STACEY M COOK (CHIEF EXECUTIVE OFFIER)
- **Authorized official phone:** (804) 276-1702

## Contact information

- **Practice address:** 1908 CHEVELLE DR, RICHMOND, VA 23235-5641
- **Practice address phone:** (804) 276-1702
- **Practice address fax:** (804) 276-6051
- **Mailing address:** 1908 CHEVELLE DR, RICHMOND, VA 23235-5641
- **Mailing address phone:** (804) 276-1702
- **Mailing address fax:** (804) 276-6051

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | SS06320 | VA | Yes |

## Other

- **Enumeration date:** 12/27/2006
- **Last updated:** 08/22/2020