Individual
MRS. WILLOW NICOLE BROADDUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCMHC, LPC, MA
Contact information
Practice address
138 OLD STAGE RD, GRANVILLE, VT 05747-9675
(802) 565-7124
Mailing address
PO BOX 165, HANCOCK, VT 05748-0165
(802) 565-7124
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
068.0134330
VT
Other
Enumeration date
07/05/2021
Last updated
04/12/2024
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