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General NPI Number Information
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NPI Number | 1689397523
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Entity Type | Organization
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Legal Business Name | BREAKING THE CYCLE, LLC
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Dates
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Enumeration Date | 09/26/2022
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Last Update Date | 05/08/2024
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Provider Practice Location Address
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Address Line | 112 S PROVIDENCE RD STE 201
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23236-3300
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Country | US
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Telephone | 804-822-0236
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Fax | 804-660-6571
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Provider Business Mailing Address
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Address Line | 112 S PROVIDENCE RD STE 201
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23236-3300
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Country | US
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Telephone | 804-822-0236
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Fax | 804-660-6571
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Authorized Official
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Title or Position | OWNER
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Name | MRS. QUATYSHA NIA JACKSON
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Credential | LCSW
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Telephone | 804-822-0236
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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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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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