Organization
BROKEN PIECES SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARQUITTA RUSSELL (AGENCY ADMINISTRATOR)
(980) 258-9315
Entity
Organization
Contact information
Practice address
2020 REMOUNT RD STE G100, GASTONIA, NC 28054-7476
(980) 258-9315
Mailing address
8021 BELLA VISTA CT, CHARLOTTE, NC 28216-2043
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
—
—
171M00000X
Case Manager/Care Coordinator
—
NC
175T00000X
Peer Specialist
—
NC
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
NC
Other
Enumeration date
06/18/2017
Last updated
11/15/2023
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