Provider Demographics
NPI:1821823873
Name:BRAZILLE, DAIZJA V
Entity type:Individual
Prefix:
First Name:DAIZJA
Middle Name:V
Last Name:BRAZILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 LITTLE RIVER LOOP APT 238
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPG
Mailing Address - State:FL
Mailing Address - Zip Code:32714-1781
Mailing Address - Country:US
Mailing Address - Phone:850-346-1749
Mailing Address - Fax:
Practice Address - Street 1:2400 S HWY 27 STE B201
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6816
Practice Address - Country:US
Practice Address - Phone:352-606-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical