Healthcare Provider Details

I. General information

NPI: 1285192096
Provider Name (Legal Business Name): ANTIONETTE BROOKINS & ASSOCIATES , CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 10/29/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3723 E DAKOTA AVE
FRESNO CA
93726-7007
US

IV. Provider business mailing address

7081 N MARKS AVE #104 PMB 184
FRESNO CA
93711-7007
US

V. Phone/Fax

Practice location:
  • Phone: 559-709-9169
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANTIONETTE DENISE BROOKINS
Title or Position: OWNER, CLINICAL DIRECTOR
Credential: LMFT
Phone: 559-709-9169