Provider Demographics
NPI:1992489249
Name:BROOKS, LADELLE YOLANDA (NBCC, LGPC)
Entity type:Individual
Prefix:
First Name:LADELLE
Middle Name:YOLANDA
Last Name:BROOKS
Suffix:
Gender:F
Credentials:NBCC, LGPC
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 2
Mailing Address - Street 2:
Mailing Address - City:NEW MIDWAY
Mailing Address - State:MD
Mailing Address - Zip Code:21775-0002
Mailing Address - Country:US
Mailing Address - Phone:301-801-8079
Mailing Address - Fax:
Practice Address - Street 1:21925 FREDERICK RD
Practice Address - Street 2:
Practice Address - City:BOYDS
Practice Address - State:MD
Practice Address - Zip Code:20841-9031
Practice Address - Country:US
Practice Address - Phone:800-491-5369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP13626101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health