Healthcare Provider Details

I. General information

NPI: 1104661024
Provider Name (Legal Business Name): BREAKING BHAD COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 PEMBROOK DR STE 300
ORLANDO FL
32810-6378
US

IV. Provider business mailing address

1800 PEMBROOK DR STE 300
ORLANDO FL
32810-6378
US

V. Phone/Fax

Practice location:
  • Phone: 407-900-4825
  • Fax:
Mailing address:
  • Phone: 407-900-4825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MALIK JIMAINE AKBAR
Title or Position: OWNER/CLINICAL THERAPIST
Credential: LMHC
Phone: 407-900-4825