Provider Demographics
NPI:1972834588
Name:BROOM, CRISTAL NICOLE
Entity Type:Individual
Prefix:
First Name:CRISTAL
Middle Name:NICOLE
Last Name:BROOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 ASHEVILLE SPRINGS CIR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-5528
Mailing Address - Country:US
Mailing Address - Phone:803-404-9423
Mailing Address - Fax:
Practice Address - Street 1:38 ROSSCRAGGON RD
Practice Address - Street 2:SUITE 38 C
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1163
Practice Address - Country:US
Practice Address - Phone:828-654-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health