Healthcare Provider Details

I. General information

NPI: 1396650867
Provider Name (Legal Business Name): MICKINA BERSHELL BROOKS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICKINA BERSHELL AVERETT MSW

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5617 PRINCETON AVE STE B
COLUMBUS GA
31904-3483
US

IV. Provider business mailing address

2 BRADDOCK CT
COLUMBUS GA
31907-5416
US

V. Phone/Fax

Practice location:
  • Phone: 706-257-0688
  • Fax:
Mailing address:
  • Phone: 706-573-8282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: