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General NPI Number Information
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NPI Number | 1598101800
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Entity Type | Individual
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Provider Name | BREEZI SHARPE-JUSTICE LPC
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Gender | Female
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Dates
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Enumeration Date | 05/14/2013
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Last Update Date | 10/27/2024
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Provider Practice Location Address
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Address Line | 739 HIGH ST STE 112
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City | PORTSMOUTH
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State | VA
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Zip | 23704-3425
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Country | US
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Telephone | 757-770-4717
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Fax |
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Provider Business Mailing Address
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Address Line | 5017 KELSO ST
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City | SUFFOLK
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State | VA
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Zip | 23435-2555
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Country | US
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Telephone | 757-513-8268
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0709025344
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0701007534
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701007534
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License Number State | VA
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