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General NPI Number Information
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NPI Number | 1477991685
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Entity Type | Organization
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Legal Business Name | BREAKING THE CHAIN COUNSELING CTR
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Dates
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Enumeration Date | 06/10/2013
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Last Update Date | 06/10/2013
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Provider Practice Location Address
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Address Line | 774 W GRAND RIVER AVE
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City | BRIGHTON
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State | MI
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Zip | 48116-2392
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Country | US
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Telephone | 810-494-7160
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Fax |
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Provider Business Mailing Address
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Address Line | 774 W GRAND RIVER AVE
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City | BRIGHTON
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State | MI
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Zip | 48116-2392
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. RICHARD SMITH
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Credential |
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Telephone | 810-494-7160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 470094
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License Number State | MI
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