Organization
BROOKSIDE SERVICES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BRENDA JOYCE WASHINGTON LMSW (PRESIDENT)
(248) 390-5919
Entity
Organization
Contact information
Practice address
55 E IROQUOIS RD, PONTIAC, MI 48341-2016
(248) 390-5919
Mailing address
PO BOX 430355, PONTIAC, MI 48343-0355
(248) 390-5919
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6801073653
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
$$$$$$$$$
SSN OF SOLE PROPRIETOR
MI
01
—
6801073653
STATE CLINICAL LICENSE
MI
Enumeration date
02/05/2007
Last updated
08/22/2020
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