Provider Demographics
NPI:1619659331
Name:BROOKS, MARCUS MONTRELL (LMFT)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:MONTRELL
Last Name:BROOKS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 WINTERBERRY LN
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23430-5640
Mailing Address - Country:US
Mailing Address - Phone:434-229-0130
Mailing Address - Fax:
Practice Address - Street 1:202 WINTERBERRY LN
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:VA
Practice Address - Zip Code:23430-5640
Practice Address - Country:US
Practice Address - Phone:434-229-0130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717002028106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist