Individual
MR. TRAVIS DEONTA BROADDUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7135 MINSTREL WAY STE 204-M2, COLUMBIA, MD 21045-5255
(301) 357-0038
Mailing address
7135 MINSTREL WAY STE 204-M2, COLUMBIA, MD 21045-5255
(301) 357-0038
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
106S00000X
Behavior Technician
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
09/30/2022
Last updated
05/08/2023
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