Provider Demographics
NPI:1851155725
Name:HER THERAPEUTIC BREAKTHROUGH
Entity Type:Organization
Organization Name:HER THERAPEUTIC BREAKTHROUGH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTIONETTE
Authorized Official - Middle Name:DOMINIQUE
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-908-4332
Mailing Address - Street 1:4370 OLD MABRY LN NE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-1927
Mailing Address - Country:US
Mailing Address - Phone:504-908-4632
Mailing Address - Fax:
Practice Address - Street 1:4370 OLD MABRY LN NE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-1927
Practice Address - Country:US
Practice Address - Phone:504-908-4632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Multi-Specialty