Provider Demographics
NPI:1710244355
Name:MUSICK, BROOKE L (MS, LCAS, LPCA)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:L
Last Name:MUSICK
Suffix:
Gender:F
Credentials:MS, LCAS, LPCA
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:LYERLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-564-4950
Mailing Address - Fax:336-564-4959
Practice Address - Street 1:1710 KERNERSVILLE MEDICAL PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-7155
Practice Address - Country:US
Practice Address - Phone:336-564-4950
Practice Address - Fax:336-564-4959
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1712101YA0400X
NC8034101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)