Provider Demographics
NPI:1194461236
Name:ROMAN, CHEROKEE BREEZE (LCSW)
Entity type:Individual
Prefix:
First Name:CHEROKEE
Middle Name:BREEZE
Last Name:ROMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHEROKEE
Other - Middle Name:BREEZE
Other - Last Name:STAPLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 UNION ST S STE 200
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-5098
Mailing Address - Country:US
Mailing Address - Phone:704-918-9741
Mailing Address - Fax:704-270-6213
Practice Address - Street 1:11 UNION ST S STE 200
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-5098
Practice Address - Country:US
Practice Address - Phone:704-918-9741
Practice Address - Fax:704-270-6213
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0175231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical