Individual
MRS. JACQUELINE BROADWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCMHC, LCAS
Contact information
Practice address
5919 OLEANDER DR STE 121, WILMINGTON, NC 28403-4757
(910) 210-6160
Mailing address
5919 OLEANDER DR STE 121, WILMINGTON, NC 28403-4757
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCAS-23554
NC
101YM0800X
Mental Health Counselor
Primary
13518
NC
Other
Enumeration date
06/28/2017
Last updated
09/20/2021
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