Healthcare Provider Details

I. General information

NPI: 1871213702
Provider Name (Legal Business Name): ERICA LASHUNDA BROOKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

988 N ILLINOIS ROUTE 3
WATERLOO IL
62298-1059
US

IV. Provider business mailing address

2213 MONTEREY DR
BELLEVILLE IL
62221-3120
US

V. Phone/Fax

Practice location:
  • Phone: 618-939-4444
  • Fax:
Mailing address:
  • Phone: 618-616-9864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number00002780
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: