Individual
JIMMY DEAN BRODERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LMHC
Contact information
Practice address
498 VALLEY VIEW DR, WINDER, GA 30680-1421
(386) 855-5444
Mailing address
498 VALLEY VIEW DR, WINDER, GA 30680-1421
(386) 855-5444
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
19022
FL
Other
Enumeration date
06/15/2021
Last updated
06/15/2021
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