Provider Demographics
NPI:1073707006
Name:WESTBROOK, WILLIAM G (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:G
Last Name:WESTBROOK
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1128 OLD POLE BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MILLS RIVER
Mailing Address - State:NC
Mailing Address - Zip Code:28759-5754
Mailing Address - Country:US
Mailing Address - Phone:828-777-9078
Mailing Address - Fax:
Practice Address - Street 1:733 2ND AVENUE
Practice Address - Street 2:
Practice Address - City:KOTZEBUE
Practice Address - State:AK
Practice Address - Zip Code:99752
Practice Address - Country:US
Practice Address - Phone:907-442-7640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-03
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5360101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103269Medicaid