Provider Demographics
NPI:1104121003
Name:STANLEY, BROOKE (LPC)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:
Last Name:STANLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:UTLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9720 CAPITAL CT
Mailing Address - Street 2:303
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-2044
Mailing Address - Country:US
Mailing Address - Phone:833-382-5433
Mailing Address - Fax:833-382-5433
Practice Address - Street 1:9720 CAPITAL CT
Practice Address - Street 2:303
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-2044
Practice Address - Country:US
Practice Address - Phone:833-382-5433
Practice Address - Fax:833-382-5433
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
VA0701006033101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health