Provider Demographics
NPI:1043828783
Name:COMLEY, BROOKE A (LMSW)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:A
Last Name:COMLEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 TOM LN
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-6469
Mailing Address - Country:US
Mailing Address - Phone:716-390-3878
Mailing Address - Fax:
Practice Address - Street 1:3395 SIXES RD STE 2302
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-9125
Practice Address - Country:US
Practice Address - Phone:404-910-3377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW007530101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty