Provider Demographics
NPI:1508211814
Name:BROOKS, ANNA BRACKNELL (LISW-CP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:BRACKNELL
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:BRACKNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:10 PATEWOOD DR STE 130
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6317
Practice Address - Country:US
Practice Address - Phone:864-522-5550
Practice Address - Fax:864-455-4540
Is Sole Proprietor?:No
Enumeration Date:2016-04-25
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
SC14678104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)