Provider Demographics
NPI:1033133616
Name:BREAKTHROUGHS: COUNSELING & RECOVERY, INC.
Entity Type:Organization
Organization Name:BREAKTHROUGHS: COUNSELING & RECOVERY, INC.
Other - Org Name:BREAKTHROUGHS COUNSELING & RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CIN DY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:FALOR
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, CAP
Authorized Official - Phone:904-419-6102
Mailing Address - Street 1:3810-3 WILLIAMSBURG PK BLVD.
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257
Mailing Address - Country:US
Mailing Address - Phone:904-419-6102
Mailing Address - Fax:904-739-2153
Practice Address - Street 1:3810-3 WILLIAMSBURG PK. BLVD.
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257
Practice Address - Country:US
Practice Address - Phone:904-419-6102
Practice Address - Fax:904-739-2153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLSW17931041C0700X
FL0416AD834400261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5199208OtherAETNA
FLX1561OtherBC/BS
FLZ4246Medicare UPIN