Provider Demographics
NPI:1477808798
Name:BROOKS, JANELL H (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANELL
Middle Name:H
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 1:2017 REFLECTION CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-7424
Mailing Address - Country:US
Mailing Address - Phone:770-483-1283
Mailing Address - Fax:
Practice Address - Street 1:1500 KLONDIKE RD SW STE A103
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-5115
Practice Address - Country:US
Practice Address - Phone:678-671-5279
Practice Address - Fax:678-562-2297
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003574103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist