Provider Demographics
NPI:1194445627
Name:BROOKS, CEDRIC LAMAR (LLPC)
Entity type:Individual
Prefix:
First Name:CEDRIC
Middle Name:LAMAR
Last Name:BROOKS
Suffix:
Gender:M
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22511 TELEGRAPH RD STE 129
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-4132
Mailing Address - Country:US
Mailing Address - Phone:248-215-2566
Mailing Address - Fax:
Practice Address - Street 1:22511 TELEGRAPH RD STE 129
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-4132
Practice Address - Country:US
Practice Address - Phone:248-215-2566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451022521101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6451022521OtherSTATE OF MICHIGAN LLPC LICENSE NUMBER