Provider Demographics
NPI:1659480168
Name:BROOKS, LAKISHA YVETTE (LCSW)
Entity Type:Individual
Prefix:
First Name:LAKISHA
Middle Name:YVETTE
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 1:1412A RUSSELL PKWY # 219
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-5583
Mailing Address - Country:US
Mailing Address - Phone:240-603-3837
Mailing Address - Fax:
Practice Address - Street 1:104 WHITING WAY STE 110
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-8054
Practice Address - Country:US
Practice Address - Phone:478-220-9865
Practice Address - Fax:478-220-7491
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD112941041C0700X
TX50011041C0700X
GACSW0045581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical