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1073025557 NPI number — ARIANNE J'NAE BROADNAX LPC-A

NPI Number: 1073025557
Health Care Provider/Practitioner: ARIANNE J'NAE BROADNAX LPC-A

Information about “1073025557” NPI (ARIANNE J'NAE BROADNAX LPC-A) exists in 1073025557 in HTML format HTML  |  1073025557 in plain Text format TXT  |  1073025557 in PDF (Portable Document Format) PDF  |  1073025557 in an XML format XML  formats.

NPI Number : 1073025557 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1073025557",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BROADNAX",
    "FirstName": "ARIANNE",
    "MiddleName": "J'NAE",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "LPC-A",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1650 HEATHER TRACE LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WINSTON SALEM",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "27127-7380",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "336-406-9843",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "6614 SHALLOWFORD RD STE 250",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LEWISVILLE",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "27023-9305",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "336-945-0137",
    "PracticeLocationAddressFaxNumber": "336-946-9084",
    "EnumerationDate": "10/24/2017",
    "LastUpdateDate": "10/24/2017",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101YM0800X",
        "TaxonomyName": "Mental Health Counselor",
        "LicenseNumber": "A13072",
        "LicenseNumberStateCode": "NC",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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