Provider Demographics
NPI:1831756790
Name:BREAKTHROUGH THERAPEUTIC SUPPORTIVE SERVICES LLC
Entity type:Organization
Organization Name:BREAKTHROUGH THERAPEUTIC SUPPORTIVE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORLA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-353-2631
Mailing Address - Street 1:PO BOX 9641
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-9641
Mailing Address - Country:US
Mailing Address - Phone:757-609-8344
Mailing Address - Fax:855-423-7971
Practice Address - Street 1:4400 PORTSMOUTH BLVD STE B
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-2542
Practice Address - Country:US
Practice Address - Phone:757-956-6840
Practice Address - Fax:855-423-7971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-24
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty