Jacqueline Broadway, LCMHC, LCAS

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

13518 Issued in NC

Practice address

5919 Oleander Dr Ste 121
Wilmington, NC 28403-4757

Phone

(910) 210-6160

NPI assigned

Jun 28, 2017

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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Not 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.

• Go Inward, PLLC

  • Clinical Social Worker
  • Wilmington, NC
  • NPI 1144926031
  NPD
• LMV Counseling, PLLC

  • Clinical Social Worker
  • Wilmington, NC
  • NPI 1447741848

  Mental Health

  NPD

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

{
    "created_epoch": "1498608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632096000000",
    "number": "1861913097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5919 OLEANDER DR STE 121",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284034757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5919 OLEANDER DR STE 121",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284034757",
            "telephone_number": "910-210-6160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADWAY",
        "first_name": "JACQUELINE",
        "name_prefix": "Mrs.",
        "credential": "LCMHC, LCAS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-28",
        "last_updated": "2021-09-20",
        "certification_date": "2021-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "LCAS-23554",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "13518",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Britthaven, Inc.
• Albert B. Britton III, M.D.
• Diane Rene Britz, LCSW,MSW,BA
• Bryan Jackson Hikino Broadbent, MD
• Brittany Broadbridge, LCMHC
• Katherine Joan Brock, FNP
• Brian Keith Brodwater, M.D.
• Tyler Andrew Broerman, PHARMD, RPH
• Margaret Brogan
• Lucas Benjamin Brogden, DO

• Mental Health Counselor in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2021; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.