Provider Demographics
NPI:1902450794
Name:BROOKS, KRISTIN LEE (A15011)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LEE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:A15011
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 RIDGEFIELD BLVD STE 190
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-6211
Mailing Address - Country:US
Mailing Address - Phone:828-670-7723
Mailing Address - Fax:
Practice Address - Street 1:1100 RIDGEFIELD BLVD STE 190
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-6211
Practice Address - Country:US
Practice Address - Phone:828-670-7723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15011101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional