Provider Demographics
NPI:1780410084
Name:BROOKS, NOELLE LACOLE CARSON
Entity type:Individual
Prefix:
First Name:NOELLE LACOLE
Middle Name:CARSON
Last Name:BROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-6907
Mailing Address - Country:US
Mailing Address - Phone:908-343-8999
Mailing Address - Fax:
Practice Address - Street 1:285 CAMBRIDGE DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6907
Practice Address - Country:US
Practice Address - Phone:908-343-8999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-24-358716106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician