MEDICARE: KEE'SHON ALIYAH BROOKS LCSWA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	P017457	NC

General Provider Information

NPI Number	:	1033937651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEE'SHON ALIYAH BROOKS LCSWA

Provider Business Mailing Address
First Line	:	2911 BAINBRIDGE DR APT G
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-1453
Country	:	US
Telephone Number	:	980-297-4300
Fax Number	:

Provider Business Practice Location Address
First Line	:	2911 BAINBRIDGE DR APT G
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-1453
Country	:	US
Telephone Number	:	980-297-4300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2024
Last Update Date	:	10/02/2024

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