MEDICARE: BREEZI SHARPE-JUSTICE LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	0709025344	VA
2	101YM0800X	Mental Health Counselor	0701007534	VA
3	222Q00000X	Developmental Therapist
4	251S00000X	Community/Behavioral Health Agency
5	101YP2500X	Professional Counselor	0701007534	VA

General Provider Information

NPI Number	:	1598101800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREEZI SHARPE-JUSTICE LPC

Provider Business Mailing Address
First Line	:	5017 KELSO ST
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23435-2555
Country	:	US
Telephone Number	:	757-513-8268
Fax Number	:

Provider Business Practice Location Address
First Line	:	739 HIGH ST STE 112
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23704-3425
Country	:	US
Telephone Number	:	757-770-4717
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2013
Last Update Date	:	10/27/2024

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