Provider Demographics
NPI:1407529779
Name:BABBLING BROOK COUNSELING SERVICES PLLC
Entity Type:Organization
Organization Name:BABBLING BROOK COUNSELING SERVICES PLLC
Other - Org Name:BROOKE A. JERNIGAN
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:ALSTON
Authorized Official - Last Name:JERNIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:540-524-9918
Mailing Address - Street 1:1140 BRAMLETT RD
Mailing Address - Street 2:
Mailing Address - City:MONETA
Mailing Address - State:VA
Mailing Address - Zip Code:24121-6246
Mailing Address - Country:US
Mailing Address - Phone:540-525-0908
Mailing Address - Fax:540-215-7226
Practice Address - Street 1:302 WASHINGTON AVE SW STE B
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4312
Practice Address - Country:US
Practice Address - Phone:540-524-9918
Practice Address - Fax:540-215-7226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-31
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA601531914Medicaid