Provider Demographics
NPI:1528793668
Name:BROUGHTON, VANESSA ANN (LPCMH)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:ANN
Last Name:BROUGHTON
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 THE GRN STE 16490
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-3618
Mailing Address - Country:US
Mailing Address - Phone:302-257-6764
Mailing Address - Fax:302-310-5068
Practice Address - Street 1:8 THE GRN STE 16490
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-3618
Practice Address - Country:US
Practice Address - Phone:302-257-6764
Practice Address - Fax:302-310-5068
Is Sole Proprietor?:No
Enumeration Date:2022-07-21
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0011150101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health