Provider Demographics
NPI:1912164161
Name:BREAK THE SILENCE COUNSELING
Entity Type:Organization
Organization Name:BREAK THE SILENCE COUNSELING
Other - Org Name:DAISY M. DEYNES BRYANT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:DAISY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DEYNES-BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:813-689-0345
Mailing Address - Street 1:206 N MOON AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-4422
Mailing Address - Country:US
Mailing Address - Phone:813-689-0345
Mailing Address - Fax:813-672-0608
Practice Address - Street 1:8626 US HIGHWAY 301 SOUTH
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569
Practice Address - Country:US
Practice Address - Phone:813-672-7908
Practice Address - Fax:813-672-0608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW8031171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty