Broadus International Group Network, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

S6963161 Issued in VA

Legal business name

BROADUS INTERNATIONAL GROUP NETWORK, LLC

Practice address

110 Coliseum Crossing
#5050
Hampton, VA 23666-5971

Phone

(757) 785-4424

Fax

(757) 785-4424

NPI assigned

Sep 3, 2017

Last updated

Nov 3, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Katesha BroadusNPI 1598166993

Title

Ceo/Founder

Phone

(240) 447-2505

Specialties & licenses 10

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Katesha Shanee Broadus, LCSW, BC-TMH

  • Clinical Social Worker
  • Hampton, VA
  • NPI 1598166993
  Authorized official Same address or phone

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

{
    "created_epoch": "1504396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698969600000",
    "number": "1295253805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 COLISEUM XING # 5050",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236665971",
            "telephone_number": "757-778-9800",
            "fax_number": "757-778-9899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 COLISEUM CROSSING",
            "address_2": "#5050",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236665971",
            "telephone_number": "757-785-4424",
            "fax_number": "757-785-4424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADUS INTERNATIONAL GROUP NETWORK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-03",
        "last_updated": "2023-11-03",
        "certification_date": "2023-11-03",
        "status": "A",
        "authorized_official_last_name": "BROADUS",
        "authorized_official_first_name": "KATESHA",
        "authorized_official_title_or_position": "CEO/FOUNDER",
        "authorized_official_telephone_number": "240-447-2505"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP1600X",
            "taxonomy_group": "",
            "desc": "Counselor, Pastoral",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "VA",
            "license": "S6963161",
            "primary": true
        },
        {
            "code": "106E00000X",
            "taxonomy_group": "",
            "desc": "Assistant Behavior Analyst",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brandi M Brinkman
• Gregory W Briscoe, M.D.
• Nefertari J Britto, MA, LPC, NCC
• Derrick Maurice Broadaway, DDS
• Tashiko Lynn Bradshaw Broadhead, LMSW
• Katesha Shanee Broadus, LCSW, BC-TMH
• Mandi Leigh Payne Brock, M.D.
• Laurel Olivia Brockenberry, PHD
• Elizabeth Broderick, MD
• Theresa Broderick, M.D.

• Community/Behavioral Health Agency in Hampton, VA
• Providers in Hampton, VA by specialty
• Community/Behavioral Health Agency in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.