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General NPI Number Information
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NPI Number | 1164179560
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Entity Type | Individual
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Provider Name | ABIGAIL C BROOKS
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Gender | Female
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Dates
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Enumeration Date | 03/05/2022
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Last Update Date | 09/06/2022
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Provider Practice Location Address
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Address Line | 18161 MORRIS AVE STE 208
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City | HOMEWOOD
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State | IL
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Zip | 60430-2141
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Country | US
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Telephone | 708-798-5433
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Fax |
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Provider Business Mailing Address
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Address Line | 3736 214TH ST
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City | MATTESON
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State | IL
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Zip | 60443-2555
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Country | US
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Telephone | 708-679-4999
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178016390
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License Number State | IL
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