Individual
MS. EBONI GRACE BROUSSARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, NCC
Contact information
Practice address
3098 ASHBY DR, MACON, GA 31204-1502
(404) 409-1039
Mailing address
3098 ASHBY DR, MACON, GA 31204-1502
(404) 409-1039
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
02/26/2018
Last updated
02/26/2018
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