Provider Demographics
NPI:1811473937
Name:BROOKS, HARRY MILES (CADC AII057410518)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:MILES
Last Name:BROOKS
Suffix:
Gender:M
Credentials:CADC AII057410518
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 E GRAND AVE APT 206B
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-3147
Mailing Address - Country:US
Mailing Address - Phone:760-845-1518
Mailing Address - Fax:
Practice Address - Street 1:550 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-1643
Practice Address - Country:US
Practice Address - Phone:760-489-6380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAII05710518101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAII057410518OtherCERTIFIED AOD COUNSELOR