Provider Demographics
NPI:1578003646
Name:BLANKENSHIP, BROOKE (MSW,LSW)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:MSW,LSW
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 415
Mailing Address - Street 2:
Mailing Address - City:CRAB ORCHARD
Mailing Address - State:WV
Mailing Address - Zip Code:25827-0415
Mailing Address - Country:US
Mailing Address - Phone:681-238-5957
Mailing Address - Fax:681-238-5958
Practice Address - Street 1:1296 ROBERT C. BYRD DRIVE
Practice Address - Street 2:
Practice Address - City:CRAB ORCHARD
Practice Address - State:WV
Practice Address - Zip Code:25827-0415
Practice Address - Country:US
Practice Address - Phone:681-238-5957
Practice Address - Fax:681-238-5958
Is Sole Proprietor?:No
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAP00943133101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)