Healthcare Provider Details

I. General information

NPI: 1760316855
Provider Name (Legal Business Name): JENNI MARIE BROOKS CPSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1052 JOHNSON ST
RAEFORD NC
28376-2022
US

IV. Provider business mailing address

1052 JOHNSON ST
RAEFORD NC
28376-2022
US

V. Phone/Fax

Practice location:
  • Phone: 910-305-1998
  • Fax:
Mailing address:
  • Phone: 910-305-1998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number2025-14847-01
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: