Healthcare Provider Details

I. General information

NPI: 1700374501
Provider Name (Legal Business Name): ANDREA BROOKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 04/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3616 E MAIN ST
COLUMBUS OH
43213
US

IV. Provider business mailing address

3616 E MAIN ST
COLUMBUS OH
43213
US

V. Phone/Fax

Practice location:
  • Phone: 614-251-0103
  • Fax:
Mailing address:
  • Phone: 614-251-0103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: