Active NPI
Deangelo Deshaun Brooks, MS, LPCA
- Professional Counselor
- Charlotte, NC
National Provider Identifier
1346795846
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 12403
- Practice address
- 5200 Park Rd Ste 218B
Charlotte, NC 28209-3650 - Phone
- (866) 700-1606
- Fax
- (866) 338-5921
- NPI assigned
- Aug 24, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | A12403 | NC | |
| Professional Counselor | 101YP2500X | 12403 | NC | Primary |
Addresses
Primary practice location
5200 Park Rd Ste 218B
Charlotte, NC 28209-3650
Mailing address
105 Teakwood Dr Apt F
Greensboro, NC 27406-8186
Phone (828) 582-2187
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A12403 | NC | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Triumph Therapeutic Services PLLC | Professional | Current | Accepting new patients |
| Sparc Network | Professional | Past | Accepting new patients |
Locations
9700 Research Dr
Ste 131
Charlotte, NC 28262
Phone (919) 504-3004
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1471996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600128000000",
"number": "1346795846",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 TEAKWOOD DR APT F",
"city": "GREENSBORO",
"state": "NC",
"postal_code": "274068186",
"telephone_number": "828-582-2187"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5200 PARK RD STE 218B",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282093650",
"telephone_number": "866-700-1606",
"fax_number": "866-338-5921"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROOKS",
"first_name": "DEANGELO",
"middle_name": "DESHAUN",
"credential": "MS, LPCA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-08-24",
"last_updated": "2020-09-15",
"certification_date": "2020-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "A12403",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "12403",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.