MEDICARE: LAKESHA BROUSSARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1720584360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKESHA BROUSSARD

Provider Business Mailing Address
First Line	:	7305 HANCOCK VILLAGE DR STE 315
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-2771
Country	:	US
Telephone Number	:	804-901-3458
Fax Number	:

Provider Business Practice Location Address
First Line	:	2545 BELLWOOD RD
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23237-4472
Country	:	US
Telephone Number	:	804-625-9868
Fax Number	:	866-781-9646

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2018
Last Update Date	:	10/27/2025

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Directions to “ LAKESHA BROUSSARD ” Practice Location

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