Individual
BRODDRICK RONZELL JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
102 IRIS ST, THIBODAUX, LA 70301-4939
(985) 414-5275
Mailing address
102 IRIS ST, THIBODAUX, LA 70301-4939
(985) 414-5275
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
8875
LA
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
07/15/2020
Last updated
04/22/2024
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