MEDICARE: BROOKE A COMLEY LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MSW007530	GA

General Provider Information

NPI Number	:	1043828783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE A COMLEY LMSW

Provider Business Mailing Address
First Line	:	1102 TOM LN
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30066-6469
Country	:	US
Telephone Number	:	716-390-3878
Fax Number	:

Provider Business Practice Location Address
First Line	:	3395 SIXES RD STE 2302
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-9125
Country	:	US
Telephone Number	:	404-910-3377
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2020
Last Update Date	:	07/20/2020

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Directions to “ BROOKE A COMLEY LMSW” Practice Location

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