Provider Demographics
NPI:1710744172
Name:BROOKS, WINFRED ELLINGTON
Entity Type:Individual
Prefix:
First Name:WINFRED
Middle Name:ELLINGTON
Last Name:BROOKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5909 GLENN DALE RD
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9117
Mailing Address - Country:US
Mailing Address - Phone:202-340-9442
Mailing Address - Fax:
Practice Address - Street 1:5909 GLENN DALE RD
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9117
Practice Address - Country:US
Practice Address - Phone:202-340-9442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor