Healthcare Provider Details

I. General information

NPI: 1164105920
Provider Name (Legal Business Name): JALESAH BROOKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 CHAPEL AVE W
CHERRY HILL NJ
08002-4610
US

IV. Provider business mailing address

110 WOODCREST RD APT 1404
CHERRY HILL NJ
08003-3665
US

V. Phone/Fax

Practice location:
  • Phone: 609-444-9531
  • Fax:
Mailing address:
  • Phone: 856-202-6787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00817200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC018929
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: