Provider Demographics
NPI:1851838072
Name:BROOKS, JOSHUA (MACL)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:BROOKS
Suffix:
Gender:M
Credentials:MACL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 LIBBIE AVE
Mailing Address - Street 2:#101
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1829
Mailing Address - Country:US
Mailing Address - Phone:804-665-4681
Mailing Address - Fax:
Practice Address - Street 1:2008 LIBBIE AVE
Practice Address - Street 2:#101
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1829
Practice Address - Country:US
Practice Address - Phone:804-665-4681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006936101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional