# BRECKENRIDGE COUNSELING SERVICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376060624
- **Authorized official:** SHERRY L VAN FOSSAN LISW-CP (OWNER/SOLE PRACTIONER)
- **Authorized official phone:** (732) 245-8505

## Contact information

- **Practice address:** 200 N MAIN ST STE 301E, GREENVILLE, SC 29601-5104
- **Practice address phone:** (732) 245-8505
- **Practice address fax:** (000) 000-0000
- **Mailing address:** 98 E MCBEE AVE UNIT 314, GREENVILLE, SC 29601-4881
- **Mailing address phone:** (732) 245-8505
- **Mailing address fax:** (000) 000-0000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | 12010 | SC | Yes |

## Other

- **Enumeration date:** 08/28/2017
- **Last updated:** 08/28/2017