Provider Demographics
NPI:1700613437
Name:GOODWIN, BROOKE (CAC)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:CAC
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CAC
Mailing Address - Street 1:905 OVERLAN STAGE RD
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-7647
Mailing Address - Country:US
Mailing Address - Phone:225-610-5708
Mailing Address - Fax:
Practice Address - Street 1:2321 HIGHWAY 80 E
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-9366
Practice Address - Country:US
Practice Address - Phone:318-600-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)