Healthcare Provider Details

I. General information

NPI: 1619564648
Provider Name (Legal Business Name): BREAKTHROUGH AUTISM SOLUTIONS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2020
Last Update Date: 12/23/2021
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5101 DUNLEA CT STE 201C
WILMINGTON NC
28405-4436
US

IV. Provider business mailing address

5101 DUNLEA CT STE 201C
WILMINGTON NC
28405-4436
US

V. Phone/Fax

Practice location:
  • Phone: 910-390-6626
  • Fax: 910-390-6627
Mailing address:
  • Phone: 910-390-6626
  • Fax: 910-390-6627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: ASHLEIGH LYNN LEUCK
Title or Position: OWNER/BEHAVIOR ANALYST
Credential: MA, LPA, BCBA
Phone: 910-390-6621