Provider Demographics
NPI:1992443808
Name:BREAKING CYCLES COUNSELING, LLC
Entity type:Organization
Organization Name:BREAKING CYCLES COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:WRAYANNE
Authorized Official - Last Name:GLAZE PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:404-372-2885
Mailing Address - Street 1:40 GOLD CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TALLAPOOSA
Mailing Address - State:GA
Mailing Address - Zip Code:30176-4339
Mailing Address - Country:US
Mailing Address - Phone:404-372-2885
Mailing Address - Fax:
Practice Address - Street 1:105 REDMOND RD NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1535
Practice Address - Country:US
Practice Address - Phone:404-372-2885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty