Provider Demographics
NPI:1144646043
Name:BREAKSPEAR, PHILIPPA J (CDP, CC)
Entity type:Individual
Prefix:MS
First Name:PHILIPPA
Middle Name:J
Last Name:BREAKSPEAR
Suffix:
Gender:F
Credentials:CDP, CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 HARRIS AVE
Mailing Address - Street 2:SUITE #102
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7001
Mailing Address - Country:US
Mailing Address - Phone:360-961-3075
Mailing Address - Fax:
Practice Address - Street 1:1106 HARRIS AVE
Practice Address - Street 2:SUITE #102
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7001
Practice Address - Country:US
Practice Address - Phone:360-961-3075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-15
Last Update Date:2014-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00004559101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)