| Organization Name: | BROOKSIDE SERVICES, PLLC |
| NPI Number: | 1013056563 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRENDA JOYCE WASHINGTON (PRESIDENT) |
| Mailing Address: | 55 E Iroquois Rd Pontiac |
| State: | MI US |
| Postal Code: | 483412016 |
| Phone Number: | 2483905919 |
| Fax Number: | |
| NPI Enumeration Date: | 02/05/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 6801073653 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |