Provider Demographics
NPI:1114374865
Name:BROOKS, EBONY (BSW)
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 ROLLING KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-9299
Mailing Address - Country:US
Mailing Address - Phone:803-297-1619
Mailing Address - Fax:
Practice Address - Street 1:309 ROLLING KNOLL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-9299
Practice Address - Country:US
Practice Address - Phone:803-297-1619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator