Provider Demographics
NPI:1508101635
Name:BROOKS, GERALD LAMONT (LMSW, CAADC, SAP)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:LAMONT
Last Name:BROOKS
Suffix:
Gender:M
Credentials:LMSW, CAADC, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2047
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49081-2047
Mailing Address - Country:US
Mailing Address - Phone:269-290-6754
Mailing Address - Fax:269-593-5920
Practice Address - Street 1:4017 W. MAIN SUITE 100
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006
Practice Address - Country:US
Practice Address - Phone:269-290-6754
Practice Address - Fax:269-593-5920
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YA0400X
MI6801095782104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)