Individual
DEBRA LYNN BRODERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDCA
Contact information
Practice address
30663 RED ROCK CT # 1, LOGAN, OH 43138-9672
(740) 888-1377
(740) 879-2970
Mailing address
30663 RED ROCK CT # 1, LOGAN, OH 43138-9672
(740) 888-1377
(740) 879-2970
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
164844
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0096642
—
OH
Enumeration date
06/21/2018
Last updated
06/21/2018
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