Individual
TAMBGRA JUANETTE BROADAWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1200 E MOREHEAD ST STE 20L, CHARLOTTE, NC 28204-2872
(704) 578-7543
(704) 578-7543
Mailing address
1200 E MOREHEAD ST STE 20L, CHARLOTTE, NC 28204-2872
(704) 578-7543
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
8319
NC
Other
Enumeration date
12/11/2010
Last updated
02/01/2018
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