Provider Demographics
NPI:1346761269
Name:BROOKS, DARRYL LAMAR JR (LCSWA)
Entity type:Individual
Prefix:MR
First Name:DARRYL
Middle Name:LAMAR
Last Name:BROOKS
Suffix:JR
Gender:M
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6165
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31706-6165
Mailing Address - Country:US
Mailing Address - Phone:229-894-1980
Mailing Address - Fax:
Practice Address - Street 1:230 S JACKSON ST STE 219
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-2888
Practice Address - Country:US
Practice Address - Phone:229-894-1980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-30
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0080731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5781587OtherCIGNA