Provider Demographics
NPI:1982116216
Name:BRODERICK, KRISTIN E (LPC, CAADC)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:E
Last Name:BRODERICK
Suffix:
Gender:F
Credentials:LPC, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 COMMERCIAL CT STE 102
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3675
Mailing Address - Country:US
Mailing Address - Phone:912-503-5744
Mailing Address - Fax:912-335-6559
Practice Address - Street 1:300 COMMERCIAL CT STE F
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2676
Practice Address - Country:US
Practice Address - Phone:912-503-5744
Practice Address - Fax:913-335-6559
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009748101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty