Healthcare Provider Details

I. General information

NPI: 1710244355
Provider Name (Legal Business Name): BROOKE L MUSICK MS, LCAS, LPCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKE LYERLY

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 KERNERSVILLE MEDICAL PKWY SUITE 101
KERNERSVILLE NC
27284-7155
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 336-564-4950
  • Fax: 336-564-4959
Mailing address:
  • Phone: 336-564-4950
  • Fax: 336-564-4959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1712
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8034
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: