NPIMap

Organization Active NPI

Broken Chains International

  • Mental Health Counselor
  • Acworth, GA
National Provider Identifier
1053727248
Registry record updated Jul 8, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
09103511 Issued in GA
Legal business name
BROKEN CHAINS INTERNATIONAL
Practice address
3950 Cobb Pkwy NW
Suite 902
Acworth, GA 30101-9532
Phone
(800) 910-5060
Fax
(800) 634-6360
NPI assigned
Jul 8, 2014
Last updated
Jul 8, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Kevin Francis Daly, MA, BCPC, BCCCNPI 1871890269
Title
Ceo
Phone
(800) 910-5060

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X 001563 GA
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X 09103511 GA Primary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X LPC007306 GA
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X APC003606 GA

Addresses

Primary practice location

3950 Cobb Pkwy NW
Suite 902
Acworth, GA 30101-9532

Mailing address

3950 Cobb Pkwy NW
Suite 902
Acworth, GA 30101-9532
Phone (800) 910-5060

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1404777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404777600000",
    "number": "1053727248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3950 COBB PKWY NW",
            "address_2": "SUITE 902",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301019532",
            "telephone_number": "800-910-5060",
            "fax_number": "800-634-6360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3950 COBB PKWY NW",
            "address_2": "SUITE 902",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301019532",
            "telephone_number": "800-910-5060",
            "fax_number": "800-634-6360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROKEN CHAINS INTERNATIONAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-08",
        "last_updated": "2014-07-08",
        "status": "A",
        "authorized_official_last_name": "DALY",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "FRANCIS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "800-910-5060",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MA, BCPC, BCCC"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": "GA",
            "license": "001563",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "GA",
            "license": "09103511",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC007306",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "APC003606",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Acworth, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.