Provider Demographics
NPI:1073728069
Name:DAVIS, BROOKS THOMAS (MA)
Entity Type:Individual
Prefix:
First Name:BROOKS
Middle Name:THOMAS
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 ROSSCRAGGON RD
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-2513
Mailing Address - Country:US
Mailing Address - Phone:828-230-9944
Mailing Address - Fax:828-225-2761
Practice Address - Street 1:825C MERRIMON AVE # 395
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-2404
Practice Address - Country:US
Practice Address - Phone:828-230-9944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301686Medicaid