Provider Demographics
NPI:1669129938
Name:BROOKS, TIFFANY DELOATCH (MSW, LCSWA)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:DELOATCH
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:MS
Other - First Name:TIFFANY
Other - Middle Name:NICOLE
Other - Last Name:DELOATCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSWA
Mailing Address - Street 1:1325 ABBITT RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-9660
Mailing Address - Country:US
Mailing Address - Phone:757-707-5581
Mailing Address - Fax:
Practice Address - Street 1:622 ROANOKE AVE STE C
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPID
Practice Address - State:NC
Practice Address - Zip Code:27870-2740
Practice Address - Country:US
Practice Address - Phone:252-541-3833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP016129104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker