Provider Demographics
NPI:1295182764
Name:MIDDLEBROOKS, MARLA ALICIA
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:ALICIA
Last Name:MIDDLEBROOKS
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 1:129 PARK DR
Mailing Address - Street 2:
Mailing Address - City:BONAIRE
Mailing Address - State:GA
Mailing Address - Zip Code:31005-3830
Mailing Address - Country:US
Mailing Address - Phone:478-213-6581
Mailing Address - Fax:
Practice Address - Street 1:129 PARK DR
Practice Address - Street 2:
Practice Address - City:BONAIRE
Practice Address - State:GA
Practice Address - Zip Code:31005-3830
Practice Address - Country:US
Practice Address - Phone:478-213-6581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-15
Last Update Date:2016-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical