Healthcare Provider Details

I. General information

NPI: 1861014276
Provider Name (Legal Business Name): DIVINE BREAKTHROUGH MINISTRIES WORLDWIDE (THE BREAKTHROUGH CENTER)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2020
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9143 HWY 178
OLIVE BRANCH MS
38654-3865
US

IV. Provider business mailing address

9217 SPEERBERRY CIR
CORDOVA TN
38016-2399
US

V. Phone/Fax

Practice location:
  • Phone: 901-850-4469
  • Fax: 248-282-9802
Mailing address:
  • Phone: 253-282-9802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH RONDELL EVERSON
Title or Position: DIRECTOR/PASTORAL COUNSELOR/MIDWIFE
Credential: PSYD, PHD, DEM
Phone: 901-850-4469