Provider Demographics
NPI:1396435947
Name:BREAKING STIGMAS HEALING CENTER LLC
Entity type:Organization
Organization Name:BREAKING STIGMAS HEALING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMESE
Authorized Official - Middle Name:A'REA
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:314-593-0188
Mailing Address - Street 1:725 KINGLAND AVE
Mailing Address - Street 2:SUITE 100 #5
Mailing Address - City:UNIVERSITY
Mailing Address - State:MO
Mailing Address - Zip Code:63130
Mailing Address - Country:US
Mailing Address - Phone:314-593-0188
Mailing Address - Fax:
Practice Address - Street 1:725 KINGLAND AVE
Practice Address - Street 2:SUITE 100 #5
Practice Address - City:UNIVERSITY
Practice Address - State:MO
Practice Address - Zip Code:63130
Practice Address - Country:US
Practice Address - Phone:314-593-0188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty