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Dominique Victoria Broadnax
Mental Health Counselor in Indiana, Pennsylvania
NPI 1679205074

Dominique Victoria Broadnax is a Mental Health Counselor based in Indiana, PA and is specialized in Mental Health. Dominique Victoria Broadnax practices in Indiana, PA. The NPI Number for Dominique Victoria Broadnax is 1679205074 and holds a License No. (Pennsylvania).

The current practice location address for Dominique Victoria Broadnax is 964 Centennial Dr, Indiana, PA and can be reached out via phone at 619-928-8393.

Location: 964 Centennial Dr, Indiana, PA, 15701-3283
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1679205074
Provider Name
Dominique Victoria Broadnax
Credential
Provider Entity Type
Individual
Gender
Female
Address
964 Centennial Dr, Indiana, PA, 15701-3283
Phone Number
619-928-8393
Fax Number
Provider Enumeration Date
06/26/2022
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
964 Centennial Dr
City
Indiana
State
Pennsylvania
Zip
15701-3283
Phone Number
619-928-8393
Fax Number
person
Provider Business Mailing Address Details
Address
964 Centennial Dr
City
Indiana
State
Pennsylvania
Zip
15701-3283
Phone Number
619-928-8393
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
101YM0800X
License No.
()
Definition
Definition to come...
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