Organization
CLOUD BREAK THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BROOKE BUCK LPC (OWNER/PSYCHOTHERAPIST)
(703) 855-4330
Entity
Organization
Contact information
Practice address
101 S WHITING ST STE 318, ALEXANDRIA, VA 22304-3416
(703) 855-4330
Mailing address
101 S WHITING ST STE 204, ALEXANDRIA, VA 22304-3416
(703) 855-4330
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1295073161
NPPES NPI NUMBER
VA
01
—
1710448725
NPPES NPI NUMBER
VA
Enumeration date
05/23/2019
Last updated
05/14/2024
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