Healthcare Provider Details

I. General information

NPI: 1205583515
Provider Name (Legal Business Name): BREAKING BARRIERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2022
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1326 S GOVERNORS AVE STE C
DOVER DE
19904-4800
US

IV. Provider business mailing address

1326 S GOVERNORS AVE STE C
DOVER DE
19904-4800
US

V. Phone/Fax

Practice location:
  • Phone: 302-612-0352
  • Fax: 302-566-2866
Mailing address:
  • Phone: 302-744-8086
  • Fax: 302-566-2866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHERRI L CLARK
Title or Position: OWNER/PROVIDER
Credential: PMHNP-BC
Phone: 302-744-8086