Provider Demographics
NPI:1336809441
Name:BROOKS, JESSICA HOLLEN (MED, LPCA, LCMHCA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:HOLLEN
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MED, LPCA, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 EBENEZER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-2774
Mailing Address - Country:US
Mailing Address - Phone:980-288-5224
Mailing Address - Fax:
Practice Address - Street 1:1420 EBENEZER RD STE 101
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2774
Practice Address - Country:US
Practice Address - Phone:980-288-5224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15912101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health