Provider Demographics
NPI:1922837913
Name:DIAMOND, BROOKE LYNN
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:LYNN
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:BROOKE
Other - Middle Name:LYNN
Other - Last Name:CORNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1700 5TH AVE S
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-5334
Mailing Address - Country:US
Mailing Address - Phone:205-530-6007
Mailing Address - Fax:
Practice Address - Street 1:1700 5TH AVE S
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-5334
Practice Address - Country:US
Practice Address - Phone:205-530-6007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04968101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor