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General NPI Number Information
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NPI Number | 1730373143
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Entity Type | Individual
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Provider Name | STEPHANIE LYNESE BROOKS LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/29/2007
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 1662 BONHAM RD
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City | BRISTOL
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State | VA
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Zip | 24201-2090
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Country | US
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Telephone | 276-644-9899
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Fax |
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Provider Business Mailing Address
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Address Line | 14546 CHIP RIDGE RD
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City | ABINGDON
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State | VA
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Zip | 24210-1876
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Country | US
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Telephone | 540-392-2334
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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 | 0904006911
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904006911
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License Number State | VA
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