Provider Demographics
NPI:1164179560
Name:BROOKS, ABIGAIL C
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:C
Last Name:BROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3736 214TH ST
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-2555
Mailing Address - Country:US
Mailing Address - Phone:708-679-4999
Mailing Address - Fax:
Practice Address - Street 1:18161 MORRIS AVE STE 208
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2141
Practice Address - Country:US
Practice Address - Phone:708-798-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-05
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178016390101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional