Provider Demographics
NPI:1689397523
Name:BREAKING THE CYCLE, LLC
Entity Type:Organization
Organization Name:BREAKING THE CYCLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:QUATYSHA
Authorized Official - Middle Name:NIA
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:804-822-0236
Mailing Address - Street 1:1904 BYRD AVE STE 314
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3029
Mailing Address - Country:US
Mailing Address - Phone:804-822-0236
Mailing Address - Fax:
Practice Address - Street 1:1904 BYRD AVE STE 314
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3029
Practice Address - Country:US
Practice Address - Phone:804-822-0236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-26
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health