Individual
KATELYN BROADUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
113 CRANEWATER DR, COLUMBIA, SC 29212-8248
(301) 542-4270
Mailing address
113 CRANEWATER DR, COLUMBIA, SC 29212-8248
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
16115
SC
Other
Enumeration date
02/13/2024
Last updated
02/13/2024
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