Provider Demographics
NPI:1457006892
Name:BROOKE GENTLY HARGROVE LLC
Entity Type:Organization
Organization Name:BROOKE GENTLY HARGROVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:GENTLY
Authorized Official - Last Name:HARGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:404-308-3166
Mailing Address - Street 1:3390 SPRING MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-2121
Mailing Address - Country:US
Mailing Address - Phone:404-308-3166
Mailing Address - Fax:
Practice Address - Street 1:3390 SPRING MEADOW CT
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-2121
Practice Address - Country:US
Practice Address - Phone:404-308-3166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty