Healthcare Provider Details

I. General information

NPI: 1174997811
Provider Name (Legal Business Name): ROBERTA DENISE BRINKLEY LCMHC, LCAS-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2015
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5709 W FRIENDLY AVE STE A
GREENSBORO NC
27410-4112
US

IV. Provider business mailing address

5709 W FRIENDLY AVE STE A
GREENSBORO NC
27410-4112
US

V. Phone/Fax

Practice location:
  • Phone: 336-986-9787
  • Fax: 336-232-1516
Mailing address:
  • Phone: 252-955-2354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number11985
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11985
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11985
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: