Provider Demographics
NPI:1801634860
Name:BROSHEARS, ASHAWNTA MARIE (RECOVERY SPECIALIST)
Entity type:Individual
Prefix:
First Name:ASHAWNTA
Middle Name:MARIE
Last Name:BROSHEARS
Suffix:
Gender:F
Credentials:RECOVERY SPECIALIST
Other - Prefix:
Other - First Name:ASHAWNTA
Other - Middle Name:MARIE
Other - Last Name:BROSHEARS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:TAE
Mailing Address - Street 1:1510 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-1032
Mailing Address - Country:US
Mailing Address - Phone:812-602-0176
Mailing Address - Fax:
Practice Address - Street 1:1510 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1032
Practice Address - Country:US
Practice Address - Phone:812-602-0176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1497502827101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor