Provider Demographics
NPI:1619564648
Name:BREAKTHROUGH AUTISM SOLUTIONS, PLLC
Entity Type:Organization
Organization Name:BREAKTHROUGH AUTISM SOLUTIONS, PLLC
Other - Org Name:BREAKTHROUGH AUTISM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEIGH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LEUCK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPA, BCBA
Authorized Official - Phone:910-390-6621
Mailing Address - Street 1:5101 DUNLEA CT STE 201C
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-4436
Mailing Address - Country:US
Mailing Address - Phone:910-390-6626
Mailing Address - Fax:910-390-6627
Practice Address - Street 1:5101 DUNLEA CT STE 201C
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-4436
Practice Address - Country:US
Practice Address - Phone:910-390-6626
Practice Address - Fax:910-390-6627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1013497379OtherNPI