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General NPI Number Information
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NPI Number | 1104384445
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Entity Type | Organization
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Legal Business Name | BREAKING BARRIERS WELLNESS AND COUNSELING PLLC
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Dates
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Enumeration Date | 03/06/2019
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Last Update Date | 03/06/2019
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Provider Practice Location Address
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Address Line | 5540 CENTERVIEW DR STE 200
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City | RALEIGH
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State | NC
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Zip | 27606-3386
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Country | US
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Telephone | 919-559-5568
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Fax | 919-371-5599
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Provider Business Mailing Address
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Address Line | 5540 CENTERVIEW DR STE 200
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City | RALEIGH
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State | NC
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Zip | 27606-3386
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Country | US
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Telephone | 919-559-5568
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Fax | 919-371-5599
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Authorized Official
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Title or Position | CEO/MENTAL HEALTH CLINICIAN
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Name | MARECIUS SAMUEL
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Credential | LPC
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Telephone | 919-559-5568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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