Provider Demographics
NPI:1720184930
Name:BROOKS, DEBORAH ANN (LCSW, ACSW,CAAS,QSAP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LCSW, ACSW,CAAS,QSAP
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 310165
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48531-0165
Mailing Address - Country:US
Mailing Address - Phone:810-908-7320
Mailing Address - Fax:
Practice Address - Street 1:115 W. FIFTH AVENUE
Practice Address - Street 2:SUITE 1
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48505-3512
Practice Address - Country:US
Practice Address - Phone:810-908-7320
Practice Address - Fax:810-877-6453
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI203961101YA0400X
MIC-01935101YA0400X
MI68010827091041C0700X
MI250346324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2052Medicare UPIN