| Breakthrough Glow, Llc | |
|
1401a Melon St Norfolk VA 23523-2009 | |
| (757) 996-1837 | |
| (213) 867-8466 |
| Full Name | Breakthrough Glow, Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 1401a Melon St, Norfolk, Virginia |
| Authorized Official Name and Position | Alycia Margaret Archer (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 7579961837 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Breakthrough Glow, Llc Po Box 4510 Norfolk VA 23523-0510 Ph: (757) 996-1837 | Breakthrough Glow, Llc 1401a Melon St Norfolk VA 23523-2009 Ph: (757) 996-1837 |
| NPI Number | 1235997164 |
|---|---|
| Provider Enumeration Date | 03/06/2024 |
| Last Update Date | 03/06/2024 |
| Certification Date | 03/06/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235997164 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
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