Provider Demographics
NPI:1457897266
Name:BREAKING FREE OF ADDICTION
Entity Type:Organization
Organization Name:BREAKING FREE OF ADDICTION
Other - Org Name:BREAKING FREE WITH HORSES
Other - Org Type:Other Name
Authorized Official - Title/Position:DRUG AND ALCOHOL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:LENNOX
Authorized Official - Suffix:
Authorized Official - Credentials:CADC II, ICADC
Authorized Official - Phone:951-443-9758
Mailing Address - Street 1:27140 PLUM ST
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92570-7720
Mailing Address - Country:US
Mailing Address - Phone:951-443-9758
Mailing Address - Fax:
Practice Address - Street 1:27140 PLUM ST
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92570-7720
Practice Address - Country:US
Practice Address - Phone:951-443-9758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA8250912101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty