Individual
ANDREA BROADNAX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3444 BRAGG BLVD, FAYETTEVILLE, NC 28303-3946
(910) 286-7873
Mailing address
882 SOUTHVIEW CIR, FAYETTEVILLE, NC 28311-0318
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
2016-3437-01
NC
347C00000X
Private Vehicle
Primary
—
NC
Other
Enumeration date
02/10/2016
Last updated
11/07/2016
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