Provider Demographics
NPI:1487227674
Name:BROOKS, TEENA LAVETTE (LCMHC, BC-TMH)
Entity Type:Individual
Prefix:
First Name:TEENA
Middle Name:LAVETTE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LCMHC, BC-TMH
Other - Prefix:MRS
Other - First Name:TEENA
Other - Middle Name:
Other - Last Name:STREETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1724 KNIGHTBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NC
Mailing Address - Zip Code:28658-9305
Mailing Address - Country:US
Mailing Address - Phone:828-244-9562
Mailing Address - Fax:
Practice Address - Street 1:2922 AUDREY DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-7268
Practice Address - Country:US
Practice Address - Phone:828-201-2496
Practice Address - Fax:704-559-3445
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13757101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty