Basic Information
| Provider Information | |||||||||
| NPI: | 1629573258 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROOKS | ||||||||
| FirstName: | ASMYNE | ||||||||
| MiddleName: | DE'TRICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 407 AHOSKIE COFIELD RD | ||||||||
| Address2: | |||||||||
| City: | AHOSKIE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 279108819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3369445446 | ||||||||
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| Practice Location | |||||||||
| Address1: | 110 W WALKER AVE | ||||||||
| Address2: | |||||||||
| City: | ASHEBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272036760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366337000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2018 | ||||||||
| LastUpdateDate: | 03/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | LCASA24130 | NC | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | A13710 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.