Provider Demographics
NPI:1851800270
Name:VIOLA-BROOKE, AMANDA CATHERINE (LPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:CATHERINE
Last Name:VIOLA-BROOKE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:CATHERINE
Other - Last Name:BROOKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3506 PROFESSIONAL CIR STE B
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-8234
Mailing Address - Country:US
Mailing Address - Phone:706-210-8855
Mailing Address - Fax:678-541-7699
Practice Address - Street 1:3506 PROFESSIONAL CIR STE B
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-8234
Practice Address - Country:US
Practice Address - Phone:706-210-8855
Practice Address - Fax:678-541-7699
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA009712101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional