Provider Demographics
NPI:1326250978
Name:BROOKS, BEVERLY DAWN (PHD)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:DAWN
Last Name:BROOKS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 VILLAGE TRCE NE BLDG 18
Mailing Address - Street 2:PAPER MILL VILLAGE OFFICE PARK
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-4081
Mailing Address - Country:US
Mailing Address - Phone:678-267-6054
Mailing Address - Fax:
Practice Address - Street 1:660 VILLAGE TRCE NE BLDG 18
Practice Address - Street 2:PAPER MILL VILLAGE OFFICE PARK
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-4081
Practice Address - Country:US
Practice Address - Phone:678-267-6054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002831103T00000X, 103TA0700X, 106H00000X
NC1844103T00000X, 103TA0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2819803AMedicare ID - Type UnspecifiedHEALTH CARE PRACTITIONER