Provider Demographics
NPI:1801462221
Name:BROOKS, MARIANNA (BCBA)
Entity type:Individual
Prefix:
First Name:MARIANNA
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:648 OLD DAMASCUS RD
Mailing Address - Street 2:
Mailing Address - City:COLQUITT
Mailing Address - State:GA
Mailing Address - Zip Code:39837-6405
Mailing Address - Country:US
Mailing Address - Phone:205-706-4171
Mailing Address - Fax:
Practice Address - Street 1:220 RIVER ST
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39817-3654
Practice Address - Country:US
Practice Address - Phone:229-495-3005
Practice Address - Fax:229-495-3018
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-24-74658103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst