Provider Demographics
NPI:1295597219
Name:BREAKING BARRIERS COUNSELING
Entity type:Organization
Organization Name:BREAKING BARRIERS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCPC
Authorized Official - Prefix:MR
Authorized Official - First Name:ERRON
Authorized Official - Middle Name:DAJUAN
Authorized Official - Last Name:LATIMORE
Authorized Official - Suffix:SR
Authorized Official - Credentials:LCPC
Authorized Official - Phone:301-801-7006
Mailing Address - Street 1:142 E AMBOISE CT
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-1357
Mailing Address - Country:US
Mailing Address - Phone:301-801-7006
Mailing Address - Fax:
Practice Address - Street 1:142 E AMBOISE CT
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-1357
Practice Address - Country:US
Practice Address - Phone:301-801-7006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)