Provider Demographics
NPI:1114112513
Name:BROOKINS, STEPHANIE MARIE (MS, NCC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:MARIE
Last Name:BROOKINS
Suffix:
Gender:F
Credentials:MS, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 13TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-3840
Mailing Address - Country:US
Mailing Address - Phone:706-322-7911
Mailing Address - Fax:706-324-2088
Practice Address - Street 1:1661 13TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-8889
Practice Address - Country:US
Practice Address - Phone:706-322-7911
Practice Address - Fax:706-324-2088
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-09
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004854101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003131338AMedicaid