Provider Demographics
NPI:1245751379
Name:BROOKS, DAVID CHARLES (LCADC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:CHARLES
Last Name:BROOKS
Suffix:
Gender:M
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 QUAIL KNOB CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-1839
Mailing Address - Country:US
Mailing Address - Phone:832-876-0466
Mailing Address - Fax:
Practice Address - Street 1:20 W 3RD ST # 1-B
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6077
Practice Address - Country:US
Practice Address - Phone:832-876-0466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA1971101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)