| Breakforth Counseling And Consulting Llc | |
|
3959 Electric Rd Ste 425 Roanoke VA 24018-4563 | |
| (540) 556-4356 | |
| (540) 266-7511 |
| Full Name | Breakforth Counseling And Consulting Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3959 Electric Rd Ste 425, Roanoke, Virginia |
| Authorized Official Name and Position | Gilbert Todd Vance (CLINICAL PSYCHOLOGIST/OWNER) |
| Authorized Official Contact | 5405564356 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Breakforth Counseling And Consulting Llc 3959 Electric Rd Ste 425 Roanoke VA 24018-4563 Ph: (540) 556-4356 | Breakforth Counseling And Consulting Llc 3959 Electric Rd Ste 425 Roanoke VA 24018-4563 Ph: (540) 556-4356 |
| NPI Number | 1609490960 |
|---|---|
| Provider Enumeration Date | 06/02/2020 |
| Last Update Date | 06/02/2020 |
| Certification Date | 06/02/2020 |
| Medicare PECOS PAC ID | 4284166638 |
|---|---|
| Medicare Enrollment ID | O20241010001915 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609490960 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Anna W Wright |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1013573005 PECOS PAC ID: 0244563682 Enrollment ID: I20190618000025 |
| Provider Name | Deneatta Michelle Roarke |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1730659053 PECOS PAC ID: 6608314604 Enrollment ID: I20240821000613 |
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