Provider Demographics
NPI:1629057807
Name:BROOKS, JOAN CINDI (LCSW)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:CINDI
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 CONIFER DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-1386
Mailing Address - Country:US
Mailing Address - Phone:910-486-7600
Mailing Address - Fax:910-483-3758
Practice Address - Street 1:383 CONIFER DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-1386
Practice Address - Country:US
Practice Address - Phone:910-486-7600
Practice Address - Fax:910-483-3758
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0030091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1200UOtherBLUE CROSS BLUE SHIELD
NC240162OtherCOMPSYCH
NC6003337Medicaid
NC90503OtherMEDCOST
NC127726OtherVALUE OPTIONS
NC90503OtherMEDCOST