Provider Demographics
NPI:1396402095
Name:AHERNE, BROOKE PAULSON (LGPC)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:PAULSON
Last Name:AHERNE
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 DECATUR AVE
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-4410
Mailing Address - Country:US
Mailing Address - Phone:843-793-7285
Mailing Address - Fax:
Practice Address - Street 1:255 WEST ST
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3427
Practice Address - Country:US
Practice Address - Phone:800-305-2089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP12162101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional