Healthcare Provider Details

I. General information

NPI: 1518872233
Provider Name (Legal Business Name): YVONNE TANIESHA BROOKS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 EXECUTIVE DR
HAMPTON VA
23666-6602
US

IV. Provider business mailing address

533 LEONARD LN
NEWPORT NEWS VA
23601-1757
US

V. Phone/Fax

Practice location:
  • Phone: 757-644-3989
  • Fax: 866-813-7798
Mailing address:
  • Phone: 757-644-3989
  • Fax: 866-813-7798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904020922
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: