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NPI Code Detail

MEDICARE: BROOKLYNN HAAS DEASE NCC, LCMHC, MA

MEDICARE: BROOKLYNN HAAS DEASE NCC, LCMHC, MA
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
1101YM0800XMental Health Counselor17747NC

General Provider Information

NPI Number : 1669106605
Entity Type Code : Individual
Provider Name (Legal Business Name) : BROOKLYNN HAAS DEASE NCC, LCMHC, MA
Provider Business Mailing Address
First Line : 17105 KENTON DR STE 201C
Second Line :
City : CORNELIUS
State : NC
Zip : 28031-5654
Country : US
Telephone Number : 704-747-3737
Fax Number :
Provider Business Practice Location Address
First Line : 17105 KENTON DR STE 201C
Second Line :
City : CORNELIUS
State : NC
Zip : 28031-5654
Country : US
Telephone Number : 704-747-3737
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2022
Last Update Date : 12/12/2025

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