Provider Demographics
NPI:1336487859
Name:BROOKS, WANDA (MS, LPC)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 NIXON DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31705-9589
Mailing Address - Country:US
Mailing Address - Phone:229-883-0905
Mailing Address - Fax:
Practice Address - Street 1:1227 NIXON DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31705-9589
Practice Address - Country:US
Practice Address - Phone:229-883-0905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007070101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health