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General NPI Number Information
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NPI Number | 1598638942
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Entity Type | Organization
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Legal Business Name | BREAKTHROUGH SUPPORTIVE SERVICES LLC
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Dates
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Enumeration Date | 09/23/2025
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 500 E MAIN ST
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City | NORFOLK
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State | VA
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Zip | 23510-2205
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Country | US
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Telephone | 757-947-8686
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Fax | 757-282-2984
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Provider Business Mailing Address
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Address Line | 500 E MAIN ST
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City | NORFOLK
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State | VA
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Zip | 23510-2205
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Country | US
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Telephone | 757-947-8686
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Fax | 757-282-2984
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Authorized Official
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Title or Position | CEO
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Name | MR. BRANDON M. TYNES
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Credential | QMHP
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Telephone | 757-947-8686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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