Provider Demographics
NPI:1942688601
Name:BROCK, DON G (DMIN, LPC)
Entity Type:Individual
Prefix:DR
First Name:DON
Middle Name:G
Last Name:BROCK
Suffix:
Gender:M
Credentials:DMIN, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701B GAULT AVE N
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35967-2627
Mailing Address - Country:US
Mailing Address - Phone:256-979-1620
Mailing Address - Fax:
Practice Address - Street 1:521 GAULT AVE N
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35967-2307
Practice Address - Country:US
Practice Address - Phone:256-273-7216
Practice Address - Fax:205-263-6462
Is Sole Proprietor?:No
Enumeration Date:2015-05-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3777101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional