Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 2526 | NC |
NPI | 1003119603 |
---|---|
Provider Name | Erica A Brooks |
First Address | Ahoskie, NC 27910-8842 |
Second Address | Ahoskie, NC 27910-8842 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2010 |
Last Update Date | 21/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
138A2 | BCBSNC (01) | NC |
6107194 | (05) | NC |