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General NPI Number Information
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NPI Number | 1356678551
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Entity Type | Organization
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Legal Business Name | BREAKTHROUGH COUNSELING LLC
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Dates
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Enumeration Date | 11/09/2009
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Last Update Date | 11/09/2009
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Provider Practice Location Address
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Address Line | 1001 FARMINGTON AVE STE 302
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City | BRISTOL
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State | CT
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Zip | 06010-3990
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Country | US
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Telephone | 860-918-3663
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Fax |
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Provider Business Mailing Address
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Address Line | 46 LAUREL LN
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City | MARLBOROUGH
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State | CT
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Zip | 06447-1151
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Country | US
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Telephone | 860-918-3663
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. FIKESOLA AYENI
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Credential | LCSW
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Telephone | 860-918-3663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 07161
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 07161
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License Number State | CT
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