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General NPI Number Information
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NPI Number | 1700383817
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Entity Type | Individual
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Provider Name | JENNIFER E BROUGHTON LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/06/2018
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Last Update Date | 11/28/2022
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Provider Practice Location Address
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Address Line | 1 FREEDOM WAY
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City | AUGUSTA
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State | GA
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Zip | 30904-6258
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Country | US
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Telephone | 67-733-0188
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Fax |
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Provider Business Mailing Address
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Address Line | 122 LECOMPTE AVE
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City | NORTH AUGUSTA
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State | SC
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Zip | 29841-3032
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Country | US
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Telephone | 434-770-7975
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC50081235
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 086698-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904009883
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License Number State | VA
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