Provider Demographics
NPI:1659894509
Name:BROOKE, ELIZABETH ANTOINETTE (MS, NCC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANTOINETTE
Last Name:BROOKE
Suffix:
Gender:F
Credentials:MS, NCC, LPC
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:ANTOINETTE
Other - Last Name:SMALLWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, NCC, LPC
Mailing Address - Street 1:10003 WEBSTER RD
Mailing Address - Street 2:
Mailing Address - City:CAMDEN ON GAULEY
Mailing Address - State:WV
Mailing Address - Zip Code:26208-7713
Mailing Address - Country:US
Mailing Address - Phone:304-226-5725
Mailing Address - Fax:304-226-3274
Practice Address - Street 1:415 MAIN ST
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-1343
Practice Address - Country:US
Practice Address - Phone:304-872-1663
Practice Address - Fax:304-872-1804
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2290101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional