Provider Demographics
NPI:1134419617
Name:BROOKS, NIKIESHA CORINE
Entity type:Individual
Prefix:MS
First Name:NIKIESHA
Middle Name:CORINE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N WILLOWBROOK AVE
Mailing Address - Street 2:UNIT K 5
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-2458
Mailing Address - Country:US
Mailing Address - Phone:310-245-5429
Mailing Address - Fax:
Practice Address - Street 1:500 N WILLOWBROOK AVE
Practice Address - Street 2:UNIT K 5
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-2458
Practice Address - Country:US
Practice Address - Phone:310-245-5429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist