Provider Demographics
NPI:1881494441
Name:SMITH-CUFFEE, BREONNA
Entity type:Individual
Prefix:
First Name:BREONNA
Middle Name:
Last Name:SMITH-CUFFEE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10429 W PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-1863
Mailing Address - Country:US
Mailing Address - Phone:804-938-2420
Mailing Address - Fax:
Practice Address - Street 1:10429 W PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-1863
Practice Address - Country:US
Practice Address - Phone:804-938-2420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704016439101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health