Healthcare Provider Details

I. General information

NPI: 1629573258
Provider Name (Legal Business Name): ASMYNE DE'TRICE BROOKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 W WALKER AVE
ASHEBORO NC
27203-6760
US

IV. Provider business mailing address

407 AHOSKIE COFIELD RD
AHOSKIE NC
27910-8819
US

V. Phone/Fax

Practice location:
  • Phone: 336-633-7000
  • Fax:
Mailing address:
  • Phone: 336-944-5446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCASA24130
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA13710
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: