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General NPI Number Information
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NPI Number | 1629573258
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Entity Type | Individual
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Provider Name | ASMYNE DE'TRICE BROOKS
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Gender | Female
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Dates
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Enumeration Date | 03/26/2018
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Last Update Date | 03/26/2018
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Provider Practice Location Address
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Address Line | 110 W WALKER AVE
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City | ASHEBORO
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State | NC
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Zip | 27203-6760
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Country | US
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Telephone | 336-633-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 407 AHOSKIE COFIELD RD
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City | AHOSKIE
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State | NC
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Zip | 27910-8819
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Country | US
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Telephone | 336-944-5446
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCASA24130
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | A13710
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License Number State | NC
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