| Provider / Organization | NPI | Date Certified |
|---|---|---|
| DOMINIQUE VICTORIA BROADNAX | 1679205074 | 2022-06-26 |
Dominique Victoria Broadnax is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1679205074. Registration indicates Dominique Victoria Broadnax is a provider of access to mental health/behavioral health providers services with a specialization in Behavioral Health & Social Service Providers, Counselor (Behavioral Health & Social Service Providers, Counselor) (Counselor: Mental Health, ) (Behavioral Health/Substance Abuse/Psychiatry, ) (Counselor Mental Health, Behavioral Health & Social Service Providers) (Counselor, )
| Entity Type | Individual |
| Provider Name | Dominique Victoria Broadnax |
| Practice Office Address | 964 CENTENNIAL DR INDIANA, PA US |
| Practice Office Telephone | 6199288393 |
| Mailing Address | 964 CENTENNIAL DR INDIANA, PA 157013283 US |
| Business Telephone | 6199288393 |
| Code | Practice | License No State |
|---|---|---|
| 101YM0800X PRIMARY | Access to Mental Health/Behavioral Health Providers Behavioral Health & Social Service Providers Counselor Behavioral Health & Social Service Providers Counselor Counselor: Mental Health Behavioral Health/Substance Abuse/Psychiatry Counselor Mental Health Behavioral Health & Social Service Providers Counselor |