Healthcare Provider Details

I. General information

NPI: 1669106605
Provider Name (Legal Business Name): BROOKLYNN HAAS DEASE NCC, LCMHC, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17105 KENTON DR STE 201C
CORNELIUS NC
28031-5654
US

IV. Provider business mailing address

17105 KENTON DR STE 201C
CORNELIUS NC
28031-5654
US

V. Phone/Fax

Practice location:
  • Phone: 704-747-3737
  • Fax:
Mailing address:
  • Phone: 704-747-3737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number17747
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: