Organization
SONYA BROADUS, LPC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KACY MARIE EAST (OFFICE MANAGER)
(251) 800-1166
Entity
Organization
Contact information
Practice address
10654 US HIGHWAY 31 STE B, SPANISH FORT, AL 36527-8691
(251) 800-1166
Mailing address
10654 US HIGHWAY 31 STE B, SPANISH FORT, AL 36527-8691
(251) 800-1166
(251) 308-1591
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3403
LICENSE
AL
Enumeration date
03/25/2021
Last updated
03/25/2021
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