Provider Demographics
NPI:1942496302
Name:BROOKS, DEBRA JO (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:JO
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-6022
Mailing Address - Country:US
Mailing Address - Phone:479-750-1151
Mailing Address - Fax:479-750-2262
Practice Address - Street 1:801 CARLTON
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762
Practice Address - Country:US
Practice Address - Phone:479-750-1151
Practice Address - Fax:479-750-2262
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC12581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical