Healthcare Provider Details

I. General information

NPI: 1841259710
Provider Name (Legal Business Name): BRUCE L BROADRICK JR. PHARMD., LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 POPLAR SPRINGS RD NW
DALTON GA
30720-7091
US

IV. Provider business mailing address

975 POPLAR SPRINGS RD NW
DALTON GA
30720-7091
US

V. Phone/Fax

Practice location:
  • Phone: 706-217-8711
  • Fax:
Mailing address:
  • Phone: 706-217-8711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH022581
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC011947
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4163
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: