Priscilla NA Broussard, LAC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

1348 Issued in LA

Practice address

2808 S Croatan Hwy
Nags Head, NC 27959-9024

Phone

(252) 441-2324

Fax

(252) 441-1994

NPI assigned

May 14, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

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

State licenses

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 and National Provider Directory roles.

• Life Journey Wellness of Louisiana

  • Mental Health Counselor
  • Bossier City, LA
  • NPI 1497347090
  NPD

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

{
    "created_epoch": "1273795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324339200000",
    "number": "1457679482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 SAPPHIRE CT STE 110",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278349079",
            "telephone_number": "252-830-7540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2808 S CROATAN HWY",
            "city": "NAGS HEAD",
            "state": "NC",
            "postal_code": "279599024",
            "telephone_number": "252-441-2324",
            "fax_number": "252-441-1994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUSSARD",
        "first_name": "PRISCILLA",
        "middle_name": "NA",
        "name_prefix": "Ms.",
        "credential": "LAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-05-14",
        "last_updated": "2011-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "1475",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "LA",
            "license": "1348",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donald Lewis Beale, MSW, LCSW
• Bear Drugs of Nags Head Inc.
• Blue Water Ear Nose and Throat, P.a.
• Jessica Cecco Boone, CCC-SLP
• Elizabeth L Brennan, PT
• Heather Brown, APRN, FNP-BC
• Rani Buglione, D.O.
• Sydne Grace Burrow, LCMHC-A, CRC
• Cary Sue Buscemi, MSW, LCSW
• Thomas M. Buttke, PH.D., D.D.S.

• Addiction (Substance Use Disorder) Counselor in Nags Head, NC
• Providers in Nags Head, NC by specialty
• Addiction (Substance Use Disorder) Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2011; 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.