Provider Demographics
NPI:1447060280
Name:BROOKS, ANDREW CHARLES SR
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:CHARLES
Last Name:BROOKS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 GRISWOLD ST STE 1112
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226-3483
Mailing Address - Country:US
Mailing Address - Phone:313-574-9205
Mailing Address - Fax:
Practice Address - Street 1:645 GRISWOLD ST STE 1112
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-3483
Practice Address - Country:US
Practice Address - Phone:313-574-9205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511187481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical