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General NPI Number Information
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NPI Number | 1205336674
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Entity Type | Individual
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Provider Name | SHARON WALLACE BROOKS LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/12/2018
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Last Update Date | 02/12/2018
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Provider Practice Location Address
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Address Line | 108 ROUNDLEAF CT
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-1240
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Country | US
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Telephone | 770-401-2235
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Fax | 770-212-2216
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Provider Business Mailing Address
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Address Line | 1029 N PEACHTREE PKWY
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-4210
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Country | US
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Telephone | 770-401-2235
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Fax | 770-212-0221
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW004906
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License Number State | GA
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