Provider Demographics
NPI:1578990776
Name:BROOK, JAMES PAUL (LCSW, LICSW, LCADC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:PAUL
Last Name:BROOK
Suffix:
Gender:M
Credentials:LCSW, LICSW, LCADC
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 1302
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30703-1302
Mailing Address - Country:US
Mailing Address - Phone:706-218-0572
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1302
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30703-1302
Practice Address - Country:US
Practice Address - Phone:706-218-0572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1123101YA0400X
KY3993101YM0800X
GACSW0064131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100333360Medicaid