Provider Demographics
NPI:1144737669
Name:BROOKS, TRINA VIRGINIA (MSW)
Entity Type:Individual
Prefix:
First Name:TRINA
Middle Name:VIRGINIA
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:TRINA
Other - Middle Name:VIRGINIA
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:4311 DEWEY AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-1399
Mailing Address - Country:US
Mailing Address - Phone:443-708-6375
Mailing Address - Fax:
Practice Address - Street 1:14 S BROADWAY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-1712
Practice Address - Country:US
Practice Address - Phone:410-276-1773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-05
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)