Provider Demographics
NPI:1356947261
Name:BACOT, BROOKE APRIL (LCSWA)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:APRIL
Last Name:BACOT
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:BANNER ELK
Mailing Address - State:NC
Mailing Address - Zip Code:28604-0098
Mailing Address - Country:US
Mailing Address - Phone:828-897-5465
Mailing Address - Fax:828-898-8513
Practice Address - Street 1:158 GRANDFATHER HOME DR
Practice Address - Street 2:
Practice Address - City:BANNER ELK
Practice Address - State:NC
Practice Address - Zip Code:28604-6154
Practice Address - Country:US
Practice Address - Phone:828-898-5465
Practice Address - Fax:828-898-8513
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0145921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP014592OtherLICENSE