Provider Demographics
NPI:1104384445
Name:BREAKING BARRIERS WELLNESS AND COUNSELING PLLC
Entity Type:Organization
Organization Name:BREAKING BARRIERS WELLNESS AND COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MENTAL HEALTH CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARECIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:919-559-5568
Mailing Address - Street 1:5540 CENTERVIEW DR STE 200
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-3386
Mailing Address - Country:US
Mailing Address - Phone:919-559-5568
Mailing Address - Fax:919-371-5599
Practice Address - Street 1:5540 CENTERVIEW DR STE 200
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-3386
Practice Address - Country:US
Practice Address - Phone:919-559-5568
Practice Address - Fax:919-371-5599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty