Provider Demographics
NPI:1932622057
Name:KESTER, BROOKE (LCSW, LCAS)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:KESTER
Suffix:
Gender:F
Credentials:LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3416 MEDICI WAY UNIT 3
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-8728
Mailing Address - Country:US
Mailing Address - Phone:252-838-2061
Mailing Address - Fax:
Practice Address - Street 1:3416 MEDICI WAY UNIT 3
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-8728
Practice Address - Country:US
Practice Address - Phone:252-838-2061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-20
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-23010101YA0400X
NCC0165551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)