Provider Demographics
NPI:1205612603
Name:BROOKS, DOUGLAS MICHAEL II (NBC-HWC)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:MICHAEL
Last Name:BROOKS
Suffix:II
Gender:M
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35268 BETH RD
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-9618
Mailing Address - Country:US
Mailing Address - Phone:704-826-5874
Mailing Address - Fax:
Practice Address - Street 1:35268 BETH RD
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-9618
Practice Address - Country:US
Practice Address - Phone:980-220-6999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A-3770816171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach