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General NPI Number Information
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NPI Number | 1669129938
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Entity Type | Individual
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Provider Name | TIFFANY DELOATCH BROOKS MSW, LCSWA
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Gender | Female
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Dates
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Enumeration Date | 03/07/2022
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Last Update Date | 03/07/2022
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Provider Practice Location Address
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Address Line | 622 ROANOKE AVE STE C
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City | ROANOKE RAPID
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State | NC
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Zip | 27870-2740
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Country | US
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Telephone | 252-541-3833
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Fax |
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Provider Business Mailing Address
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Address Line | 1325 ABBITT RD
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City | WILLIAMSTON
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State | NC
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Zip | 27892-9660
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Country | US
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Telephone | 757-707-5581
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | P016129
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License Number State | NC
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