Provider Demographics
NPI:1023233269
Name:BROOKS, JEFF R (LCAS)
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:R
Last Name:BROOKS
Suffix:
Gender:M
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 CASCADE ST
Mailing Address - Street 2:
Mailing Address - City:MARS HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28754-8719
Mailing Address - Country:US
Mailing Address - Phone:843-300-5272
Mailing Address - Fax:
Practice Address - Street 1:525 CASCADE ST
Practice Address - Street 2:
Practice Address - City:MARS HILL
Practice Address - State:NC
Practice Address - Zip Code:28754-8719
Practice Address - Country:US
Practice Address - Phone:843-300-5272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC956101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)