| Breakthrough Therapeutic Supportive Services Llc | |
|
3026 Tyre Neck Road Ste J Portsmouth VA 23703-2526 | |
| (757) 353-2631 | |
| (855) 423-7971 |
| Full Name | Breakthrough Therapeutic Supportive Services Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 3026 Tyre Neck Road Ste J, Portsmouth, Virginia |
| Authorized Official Name and Position | Dorla Johnson (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 7573532631 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Breakthrough Therapeutic Supportive Services Llc Po Box 9641 Chesapeake VA 23321-9641 Ph: (757) 609-8344 | Breakthrough Therapeutic Supportive Services Llc 3026 Tyre Neck Road Ste J Portsmouth VA 23703-2526 Ph: (757) 353-2631 |
| NPI Number | 1831756790 |
|---|---|
| Provider Enumeration Date | 05/24/2019 |
| Last Update Date | 05/06/2020 |
| Certification Date | 05/06/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831756790 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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