Healthcare Provider Details

I. General information

NPI: 1528169000
Provider Name (Legal Business Name): KAY NEWBERRY BROOKS L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 S MAIN ST
BLAKELY GA
39823-2267
US

IV. Provider business mailing address

PO BOX 367
BLAKELY GA
39823-0367
US

V. Phone/Fax

Practice location:
  • Phone: 229-724-7610
  • Fax: 229-724-7613
Mailing address:
  • Phone: 229-724-7610
  • Fax: 229-724-7613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC003098
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: