Individual
JERRIOD NICHOLAS BROADNAX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LADAC, NCAC-II, CFC
Contact information
Practice address
509 E. MILSAP ROAD, SUITE 9, FAYETTEVILLE, AR 72703
(479) 879-7038
(479) 340-0500
Mailing address
2926 N. SUSAN CAROL LANE, FAYETTEVILLE, AR 72703
(479) 445-8142
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
28533
IN
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
333L
AR
101YP2500X
Professional Counselor
016701
VA
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
12/04/2006
Last updated
08/10/2021
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