Lisa K Broussard, LCSW008306

NPI #1952045338 in Jasper, Georgia

Provider Information

NPI Number: 1952045338
Entity Type: Individual
Name: Lisa K Broussard, LCSW008306
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Social Worker - Clinical
Credential: LCSW008306
Enumeration Date: Apr 22, 2022
Last Updated: Jul 3, 2023

Practice Location

Address: 27 S MAIN ST
City: Jasper
State: Georgia
ZIP Code: 30143-1600
Phone: (678) 230-5164

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor - Mental Health — Mental Health	101YM0800X
Social Worker - Clinical — Clinical	1041C0700X	Primary

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