Provider Demographics
NPI:1396346300
Name:BROOKS, ELVIS F JR (LPC)
Entity type:Individual
Prefix:
First Name:ELVIS
Middle Name:F
Last Name:BROOKS
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1576 OAKLAND CHASE PKWY
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-5736
Mailing Address - Country:US
Mailing Address - Phone:804-638-4009
Mailing Address - Fax:
Practice Address - Street 1:1576 OAKLAND CHASE PKWY
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23231-5736
Practice Address - Country:US
Practice Address - Phone:804-638-4009
Practice Address - Fax:804-226-1069
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010007101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0701010007Medicaid