Provider Demographics
NPI:1972284958
Name:BREAKING CYCLES COUNSELING
Entity Type:Organization
Organization Name:BREAKING CYCLES COUNSELING
Other - Org Name:BREAKING CYCLES COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KALISHA KORAN
Authorized Official - Middle Name:AYISHA
Authorized Official - Last Name:VAULT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:424-420-7172
Mailing Address - Street 1:4193 FLAT ROCK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-7113
Mailing Address - Country:US
Mailing Address - Phone:951-386-8119
Mailing Address - Fax:
Practice Address - Street 1:4193 FLAT ROCK DR STE 200
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-7113
Practice Address - Country:US
Practice Address - Phone:951-386-8119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty