Provider Demographics
NPI:1013482769
Name:BREAKTHROUGH COUNSELING, COACHING AND CONSULTING LLC
Entity type:Organization
Organization Name:BREAKTHROUGH COUNSELING, COACHING AND CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SHANNA
Authorized Official - Middle Name:AMANDA
Authorized Official - Last Name:JEFFERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, LISW-CP/S
Authorized Official - Phone:803-743-2753
Mailing Address - Street 1:PO BOX 29144
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30359-0144
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:866-923-0754
Practice Address - Street 1:2903 GALAHAD WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-9147
Practice Address - Country:US
Practice Address - Phone:404-496-4614
Practice Address - Fax:866-923-0754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health