Provider Demographics
NPI:1902484538
Name:BROOKS, ERIKA (RBT)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 MERRIBEE LN
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-2242
Mailing Address - Country:US
Mailing Address - Phone:757-646-3622
Mailing Address - Fax:
Practice Address - Street 1:10221 FORD AVE STE 1
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-0259
Practice Address - Country:US
Practice Address - Phone:912-445-6063
Practice Address - Fax:912-445-6064
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-21-161979106S00000X
GA1-23-69379103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician