Provider Demographics
NPI:1982087706
Name:KRZOS, BROOKE (LCMHC)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:KRZOS
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9175 E LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CALABASH
Mailing Address - State:NC
Mailing Address - Zip Code:28467-2793
Mailing Address - Country:US
Mailing Address - Phone:919-323-6957
Mailing Address - Fax:
Practice Address - Street 1:7224 JANSTON DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-1082
Practice Address - Country:US
Practice Address - Phone:919-753-1080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11537101YM0800X
NCA11537101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health