MEDICARE: BREAKTHROUGH BEHAVIORAL HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1598611295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREAKTHROUGH BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	20 E TABB ST STE 201B
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23803-4560
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 E TABB ST STE 201B
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23803-4560
Country	:	US
Telephone Number	:	804-898-5322
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JEFFREY DODSON
Credential	:
Telephone Number	:	804-898-5322

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	03/06/2026

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