Provider Demographics
NPI:1043194822
Name:TODORA, BROOKE (INTERN)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:TODORA
Suffix:
Gender:F
Credentials:INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8130 JEANIE LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37938-3164
Mailing Address - Country:US
Mailing Address - Phone:865-214-0354
Mailing Address - Fax:
Practice Address - Street 1:400 PARK RD STE 220
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-8807
Practice Address - Country:US
Practice Address - Phone:865-366-1425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health