Individual
MARK SHANNON BROUSSARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAC, CCS
Contact information
Practice address
5431 SUPERIOR DR, BATON ROUGE, LA 70816-6044
(225) 964-5000
Mailing address
6421 PERKINS RD STE A, BATON ROUGE, LA 70808-6200
(225) 924-3000
(225) 924-3030
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
661
LA
Other
Enumeration date
03/01/2018
Last updated
03/01/2018
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