Healthcare Provider Details

I. General information

NPI: 1407574866
Provider Name (Legal Business Name): ANNETTE LASHANNON HILLS-BROOKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2022
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 S BRIGHTLEAF BLVD
SMITHFIELD NC
27577-4385
US

IV. Provider business mailing address

831 S BRIGHTLEAF BLVD
SMITHFIELD NC
27577-4385
US

V. Phone/Fax

Practice location:
  • Phone: 919-300-4315
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP018090
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: