Provider Demographics
NPI:1164731261
Name:BROOKS, LISA M (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 DOCK ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-4936
Mailing Address - Country:US
Mailing Address - Phone:910-254-9898
Mailing Address - Fax:910-254-9818
Practice Address - Street 1:1501 DOCK ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-4936
Practice Address - Country:US
Practice Address - Phone:910-254-9898
Practice Address - Fax:910-254-9818
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC005740101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health