Provider Demographics
NPI:1649011883
Name:BREAKTHROUGH COMMUNITY DEVELOPMENT CORPORATION
Entity type:Organization
Organization Name:BREAKTHROUGH COMMUNITY DEVELOPMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HAWANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:JERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-873-0608
Mailing Address - Street 1:1831 FOREST DR STE G
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-4430
Mailing Address - Country:US
Mailing Address - Phone:443-221-7447
Mailing Address - Fax:
Practice Address - Street 1:1831 FOREST DR STE G
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-4430
Practice Address - Country:US
Practice Address - Phone:443-221-7447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BREAKTHROUGH COMMUNITY DEVELOPMENT CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty