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General NPI Number Information
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NPI Number | 1609490960
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Entity Type | Organization
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Legal Business Name | BREAKFORTH COUNSELING AND CONSULTING LLC
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Dates
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Enumeration Date | 06/02/2020
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Last Update Date | 06/02/2020
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Provider Practice Location Address
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Address Line | 3959 ELECTRIC RD STE 425
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City | ROANOKE
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State | VA
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Zip | 24018-4563
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Country | US
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Telephone | 540-556-4356
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Fax | 540-266-7511
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Provider Business Mailing Address
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Address Line | 3959 ELECTRIC RD STE 425
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City | ROANOKE
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State | VA
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Zip | 24018-4563
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Country | US
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Telephone | 540-556-4356
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST/OWNER
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Name | DR. GILBERT TODD VANCE
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Credential | PHD
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Telephone | 540-556-4356
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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