Provider Demographics
NPI:1629792858
Name:BROSCHART, ALLISON (ALC)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:BROSCHART
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1462 PARAMOUNT DR APT 3C
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-4805
Mailing Address - Country:US
Mailing Address - Phone:803-537-0519
Mailing Address - Fax:
Practice Address - Street 1:113 LONGWOOD DR SW STE C
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4511
Practice Address - Country:US
Practice Address - Phone:256-886-9443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04189101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor