Provider Demographics
NPI:1598243131
Name:BROOKS, NISHELLE D (LCSW-A)
Entity Type:Individual
Prefix:MRS
First Name:NISHELLE
Middle Name:D
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 RIVER HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-5804
Mailing Address - Country:US
Mailing Address - Phone:919-521-2841
Mailing Address - Fax:
Practice Address - Street 1:229 RIVER HILLS DR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27527-5804
Practice Address - Country:US
Practice Address - Phone:919-521-2841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 101Y00000X
NCP0129291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical