Provider Demographics
NPI:1134996515
Name:BREAK THE CYCLE COUNSELING LLC
Entity type:Organization
Organization Name:BREAK THE CYCLE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAOIT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-S
Authorized Official - Phone:214-929-9311
Mailing Address - Street 1:308 LIVE OAK CT
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-4566
Mailing Address - Country:US
Mailing Address - Phone:214-929-9311
Mailing Address - Fax:
Practice Address - Street 1:7 COTTONTAIL CT
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-6699
Practice Address - Country:US
Practice Address - Phone:214-929-9311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-06
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty