Organization
BROKEN PIECES SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARQUITA RUSSELL (OPERATIONS)
(980) 258-9315
Entity
Organization
Contact information
Practice address
2020 REMOUNT RD, GASTONIA, NC 28054-7476
(980) 355-3737
Mailing address
2020 REMOUNT RD STE G-100B, GASTONIA, NC 28054-7476
(980) 355-3737
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
106S00000X
Behavior Technician
—
—
175T00000X
Peer Specialist
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
252Y00000X
Early Intervention Provider Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
374U00000X
Home Health Aide
—
—
385H00000X
Respite Care
—
—
385HR2055X
Child Mental Illness Respite Care
—
—
385HR2065X
Child Physical Disabilities Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00571688
—
NC
05
—
GP7951
—
SC
Enumeration date
08/22/2017
Last updated
08/15/2023
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