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NPI Code Detail

MEDICARE: BREAKING BARRIERS WELLNESS AND COUNSELING PLLC

MEDICARE: BREAKING BARRIERS WELLNESS AND COUNSELING PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0855XAdolescent and Children Mental Health Clinic/Center
2261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center
3101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1104384445
Entity Type Code : Organization
Provider Name (Legal Business Name) : BREAKING BARRIERS WELLNESS AND COUNSELING PLLC
Provider Business Mailing Address
First Line : 5540 CENTERVIEW DR STE 200
Second Line :
City : RALEIGH
State : NC
Zip : 27606-3386
Country : US
Telephone Number : 919-559-5568
Fax Number : 919-371-5599
Provider Business Practice Location Address
First Line : 5540 CENTERVIEW DR STE 200
Second Line :
City : RALEIGH
State : NC
Zip : 27606-3386
Country : US
Telephone Number : 919-559-5568
Fax Number : 919-371-5599
Authorized Official
Title or Position : CEO/MENTAL HEALTH CLINICIAN
Name : MARECIUS SAMUEL
Credential : LPC
Telephone Number : 919-559-5568
Provider Enumeration Date : 03/06/2019
Last Update Date : 03/06/2019

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