Provider Demographics
NPI:1013467992
Name:BREEZE, DARONIESHA BRIANNA (SW)
Entity type:Individual
Prefix:
First Name:DARONIESHA
Middle Name:BRIANNA
Last Name:BREEZE
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:DARONIESHA
Other - Middle Name:BRIANNA
Other - Last Name:GRANDBERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SW
Mailing Address - Street 1:PO BOX 751461
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1461
Mailing Address - Country:US
Mailing Address - Phone:843-792-6200
Mailing Address - Fax:
Practice Address - Street 1:171 ASHLEY AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-2405
Practice Address - Country:US
Practice Address - Phone:843-792-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
SC14026104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker