MEDICARE: ALICIA BROWN, PSYD, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1154184620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALICIA BROWN, PSYD, LLC

Provider Business Mailing Address
First Line	:	3829 ROSWELL RD
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-6236
Country	:	US
Telephone Number	:	404-997-2586
Fax Number	:

Provider Business Practice Location Address
First Line	:	3829 ROSWELL RD
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-6236
Country	:	US
Telephone Number	:	404-997-2586
Fax Number	:

Authorized Official
Title or Position	:	OWNER / PSYCHOLOGIST
Name	:	ALICIA BROWN
Credential	:	PSYD
Telephone Number	:	404-997-2586

Provider Enumeration Date	:	02/06/2024
Last Update Date	:	02/06/2024

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