Healthcare Provider Details

I. General information

NPI: 1568861516
Provider Name (Legal Business Name): BREAKTHROUGHS COUNSELING AND RECOVERY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2014
Last Update Date: 08/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810-3 WILLIAMSBURG PARK BLVD
JACKSONVILLE FL
32257-9220
US

IV. Provider business mailing address

3810-3 WILLIAMSBURG PARK BLVD
JACKSONVILLE FL
32257-9220
US

V. Phone/Fax

Practice location:
  • Phone: 904-419-6102
  • Fax: 904-739-2153
Mailing address:
  • Phone: 904-419-6102
  • Fax: 904-739-2153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH3602
License Number StateFL

VIII. Authorized Official

Name: CINDY BETH FALOR
Title or Position: OWNER
Credential: LMHC, CAP
Phone: 904-419-6102