Katesha Shanee Broadus, LCSW, BC-TMH

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904010149 Issued in VA

Practice address

110 Coliseum Crossing #5050
Hampton, VA 23666

Phone

(757) 785-4424

NPI assigned

Sep 4, 2014

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

Other names 1

• Ms. Katesha Shanee Cromwell Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

• Mindset Adjusted Community Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Hampton, VA
  • NPI 1184373938

  Clinical

  NPD Authorized official
• The Center for Men, LLC

  • Community/Behavioral Health Agency
  • Richmond, VA
  • NPI 1073176525
  NPD Authorized official

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

{
    "created_epoch": "1409788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1598166993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 COLISEUM CROSSING",
            "address_2": "#5050",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236665971",
            "telephone_number": "757-785-4424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 COLISEUM CROSSING #5050",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "23666",
            "telephone_number": "757-785-4424"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2025 E Main St Ste 104-131",
            "address_purpose": "LOCATION",
            "city": "Richmond",
            "state": "VA",
            "postal_code": "232237069",
            "country_code": "US",
            "telephone_number": "240-447-2505",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROADUS",
        "first_name": "KATESHA",
        "middle_name": "SHANEE",
        "name_prefix": "Mrs.",
        "credential": "LCSW, BC-TMH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-04",
        "last_updated": "2023-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P009061",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904010149",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "katesha.broadus@villagemindsetllc.com",
            "affiliation": "Y",
            "endpointDescription": "CEO/Founder Email",
            "affiliationName": "Broadus International Group Network, LLC",
            "address_1": "110 Coliseum Crossing #5050",
            "city": "Hampton",
            "state": "VA",
            "country_code": "US",
            "postal_code": "23666",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KATESHA",
            "last_name": "CROMWELL",
            "middle_name": "SHANEE",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Gregory W Briscoe, M.D.
• Nefertari J Britto, MA, LPC, NCC
• Derrick Maurice Broadaway, DDS
• Tashiko Lynn Bradshaw Broadhead, LMSW
• Broadus International Group Network, LLC
• Mandi Leigh Payne Brock, M.D.
• Laurel Olivia Brockenberry, PHD
• Elizabeth Broderick, MD
• Theresa Broderick, M.D.
• Debra Ann Brooks, LCSW

• Clinical Social Worker in Hampton, VA
• Providers in Hampton, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 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.