Provider Demographics
NPI:1700870490
Name:BROOKS, SUSAN C (MS, LMFT)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:C
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 N CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-2430
Mailing Address - Country:US
Mailing Address - Phone:252-443-5870
Mailing Address - Fax:252-443-9101
Practice Address - Street 1:112 N CIRCLE DR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2430
Practice Address - Country:US
Practice Address - Phone:252-443-5870
Practice Address - Fax:252-443-9101
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC 510101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC131WEOtherBLUE CROSS BLUE SHIELD
NC131WEOtherSTATE EMPLOYEES & TEACHER