Provider Demographics
NPI:1003119603
Name:BROOKS, ERICA A
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:A
Last Name:BROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:A
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPA
Mailing Address - Street 1:1321 FIRST ST W
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-8842
Mailing Address - Country:US
Mailing Address - Phone:252-209-8932
Mailing Address - Fax:
Practice Address - Street 1:1321 FIRST ST W
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-8842
Practice Address - Country:US
Practice Address - Phone:252-209-8932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2526103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC138A2OtherBCBSNC
NC6107194Medicaid