Provider Demographics
NPI:1245941699
Name:POWERS, BROOKE
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:POWERS
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 1:192 WATER FALLS RD
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-9451
Mailing Address - Country:US
Mailing Address - Phone:574-536-8100
Mailing Address - Fax:
Practice Address - Street 1:614 HOWARD ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28608-0020
Practice Address - Country:US
Practice Address - Phone:828-262-3180
Practice Address - Fax:828-262-3182
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6249103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling