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Individual
REBECCA BROADDUS
Active
Individual
REBECCA BROADDUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LISW-S, LICDC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LICDC.162510
OH
104100000X
Social Worker
S.1502432
OH
1041C0700X
Clinical Social Worker
Primary
I.2203547
OH
Other
Enumeration date
05/11/2017
Last updated
11/21/2024
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