Provider Demographics
NPI:1336745165
Name:HARRIS, BROOKE CHRISTIAN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:CHRISTIAN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4073 HIGHWAY 53
Mailing Address - Street 2:
Mailing Address - City:HOSCHTON
Mailing Address - State:GA
Mailing Address - Zip Code:30548-2305
Mailing Address - Country:US
Mailing Address - Phone:770-882-5884
Mailing Address - Fax:
Practice Address - Street 1:4073 HIGHWAY 53
Practice Address - Street 2:
Practice Address - City:HOSCHTON
Practice Address - State:GA
Practice Address - Zip Code:30548-2305
Practice Address - Country:US
Practice Address - Phone:770-882-5884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011780101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional