Provider Demographics
NPI:1265276968
Name:BROOKS, MEAGAN (LLMSW)
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 ROSEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1902
Mailing Address - Country:US
Mailing Address - Phone:313-819-4204
Mailing Address - Fax:
Practice Address - Street 1:595 FOREST AVE STE 11A
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1777
Practice Address - Country:US
Practice Address - Phone:313-819-4204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511183281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical