Healthcare Provider Details

I. General information

NPI: 1578499851
Provider Name (Legal Business Name): BROOKE'S HOUSE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17670 TECHNOLOGY BLVD
HAGERSTOWN MD
21740-2074
US

IV. Provider business mailing address

17670 TECHNOLOGY BLVD
HAGERSTOWN MD
21740-2074
US

V. Phone/Fax

Practice location:
  • Phone: 443-987-0974
  • Fax:
Mailing address:
  • Phone: 240-267-2230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MINDY L JENKINS
Title or Position: CFO
Credential:
Phone: 240-267-2230