Provider Demographics
NPI:1861014276
Name:DIVINE BREAKTHROUGH MINISTRIES WORLDWIDE (THE BREAKTHROUGH CENTER)
Entity Type:Organization
Organization Name:DIVINE BREAKTHROUGH MINISTRIES WORLDWIDE (THE BREAKTHROUGH CENTER)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/PASTORAL COUNSELOR/MIDWIFE
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:RONDELL
Authorized Official - Last Name:EVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, PHD, DEM
Authorized Official - Phone:901-850-4469
Mailing Address - Street 1:9217 SPEERBERRY CIR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-2399
Mailing Address - Country:US
Mailing Address - Phone:253-282-9802
Mailing Address - Fax:
Practice Address - Street 1:9143 HWY 178
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-3865
Practice Address - Country:US
Practice Address - Phone:901-850-4469
Practice Address - Fax:248-282-9802
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIVINE BREAKTHROUGH MINISTRIES WORLDWIDE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-08
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty
No176B00000XOther Service ProvidersMidwifeGroup - Single Specialty