Provider Demographics
NPI:1861022527
Name:BROOKS, DEIDRE DENISE (CT)
Entity Type:Individual
Prefix:MRS
First Name:DEIDRE
Middle Name:DENISE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:CT
Other - Prefix:MS
Other - First Name:DEIDRE
Other - Middle Name:
Other - Last Name:WOLFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1635 WINFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:NASHPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43830-9042
Mailing Address - Country:US
Mailing Address - Phone:740-689-7965
Mailing Address - Fax:
Practice Address - Street 1:1565 BOWERS LN
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1021
Practice Address - Country:US
Practice Address - Phone:740-214-6443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2303928101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional