Provider Demographics
NPI:1962970293
Name:BROOKS, EBONY MORIAH (LCMHC)
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:MORIAH
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 N CHARLOTTE AVE STE A105
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-2525
Mailing Address - Country:US
Mailing Address - Phone:980-425-7875
Mailing Address - Fax:704-289-9263
Practice Address - Street 1:1501 N CHARLOTTE AVE STE A105
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-2525
Practice Address - Country:US
Practice Address - Phone:980-425-7875
Practice Address - Fax:704-289-9263
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-23931101YA0400X, 101YA0400X
NC14085101YP2500X, 101YM0800X
NCA14085101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional