Healthcare Provider Details

I. General information

NPI: 1972442291
Provider Name (Legal Business Name): JENISE NICOLE-BRITT BROOME LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E. CORK ST., SUITE 35
WINCHESTER VA
22601
US

IV. Provider business mailing address

6028 SPINNAKER COVE CT
SUFFOLK VA
23435-3169
US

V. Phone/Fax

Practice location:
  • Phone: 540-431-5909
  • Fax:
Mailing address:
  • Phone: 757-870-5795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701015666
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: