Jimmy Dean Broderick, MS, LMHC
Individual provider Active NPI Professional Counselor · Winder, GA
NPI 1962070136 · NPPES record last updated Jun 15, 2021
Key facts
- NPI
- 1962070136
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 19022 (FL)
- Practice address
- 498 Valley View Dr
Winder, GA 30680-1421 - Phone
- (386) 855-5444
- NPI assigned
- Jun 15, 2021
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19022 | FL | MD | Professional Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 19022 | FL | Yes |
Addresses
Primary practice location
498 Valley View Dr
Winder, GA 30680-1421
Mailing address
498 Valley View Dr
Winder, GA 30680-1421
Phone (386) 855-5444
Other providers in Winder, GA
- Lee Lindsey Bleshoy
- Blue Blossom Care ABA Therapy LLLP
- Matrisha Boddie
- Rebecca Booth
- Jennifer Rose Boswell
- Cheyla Brookens
- Jamila Brooks
- Brown Family Health Center LLC
- Emmacarrie Graquitta Brown
- Jessica Brown
All providers in Winder, GA · Professional Counselor in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 15, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.