Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 25897 | NC |
NPI | 1003458373 |
---|---|
Provider Name | Charnyka Desiree Brooks |
First Address | Sanford, NC 27331-2036 |
Second Address | Sanford, NC 27330-3967 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2019 |
Last Update Date | 08/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
25897 | NCSAPPB (01) | NC |