Provider Demographics
NPI:1669856548
Name:BROOKS, HEATHER (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7809 SARDIS RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-2757
Mailing Address - Country:US
Mailing Address - Phone:704-363-3777
Mailing Address - Fax:803-845-4977
Practice Address - Street 1:7809 SARDIS RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-2757
Practice Address - Country:US
Practice Address - Phone:980-313-5819
Practice Address - Fax:803-548-3695
Is Sole Proprietor?:No
Enumeration Date:2015-07-10
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3153103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst