Provider Demographics
NPI:1659306876
Name:ROOKER, MICHELLE R (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:ROOKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:R
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:420 HUDGINS RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-4172
Mailing Address - Country:US
Mailing Address - Phone:540-845-0763
Mailing Address - Fax:866-455-5064
Practice Address - Street 1:420 HUDGINS RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-4172
Practice Address - Country:US
Practice Address - Phone:540-845-0763
Practice Address - Fax:866-455-5064
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2019-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904006644101YM0800X, 1041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA190002113Medicare PIN