Eboni Grace Broussard, MA, NCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Practice address

3098 Ashby Dr
Macon, GA 31204-1502

Phone

(404) 409-1039

NPI assigned

Feb 26, 2018

Last updated

Feb 26, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Christopher Dennis MD PLLC

  • Psychiatry Physician
  • Johns Creek, GA
  • NPI 1588090229
  Medicare reassignment NPD
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  GA, Professional

  Medicare reassignment NPD
• Sondermind Provider Network LLC

  • Clinical Social Worker
  • Denver, CO
  • NPI 1760854442

  GA, Professional

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1519603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1519603200000",
    "number": "1053812982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3098 ASHBY DR",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312041502",
            "telephone_number": "404-409-1039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3098 ASHBY DR",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312041502",
            "telephone_number": "404-409-1039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUSSARD",
        "first_name": "EBONI",
        "middle_name": "GRACE",
        "name_prefix": "Ms.",
        "credential": "MA, NCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-02-26",
        "last_updated": "2018-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Virginia Shealy Brooks, PT, DPT
• William P Brooks, M.D.
• William White Brooks, MD
• Sharon K Broom, ARNP
• Sandra Bernette Broomfield, NURSE PRACTITIONER
• Corretta Stephanie Brown-Spencer, DDS
• Angela Gaynell Brown
• Brandon Brown
• Brittney Nicole Brown
• Carol Greene Brown, LMFT

• Professional Counselor in Macon, GA
• Providers in Macon, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.