| Breaking Cycles Counseling | |
|
4193 Flat Rock Dr Ste 200 Riverside CA 92505-7113 | |
| (951) 386-8119 | |
| Not Available |
| Full Name | Breaking Cycles Counseling |
|---|---|
| Speciality | Social Worker |
| Location | 4193 Flat Rock Dr Ste 200, Riverside, California |
| Authorized Official Name and Position | Kalisha Koran Ayisha Vault (OWNER) |
| Authorized Official Contact | 4244207172 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Breaking Cycles Counseling 4193 Flat Rock Dr Ste 200 Riverside CA 92505-7113 Ph: (951) 386-8119 | Breaking Cycles Counseling 4193 Flat Rock Dr Ste 200 Riverside CA 92505-7113 Ph: (951) 386-8119 |
| NPI Number | 1972284958 |
|---|---|
| Provider Enumeration Date | 07/31/2023 |
| Last Update Date | 09/19/2023 |
| Certification Date | 09/19/2023 |
| Medicare PECOS PAC ID | 4082078027 |
|---|---|
| Medicare Enrollment ID | O20230911000920 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972284958 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kalisha Koran Ayisha Vault |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396307070 PECOS PAC ID: 7012313133 Enrollment ID: I20210914003840 |
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