Healthcare Provider Details

I. General information

NPI: 1245740943
Provider Name (Legal Business Name): DARNELL BROWN COMMUNITY DEVELOPMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

922 GARLAND AVE
TEXARKANA AR
71854-5055
US

IV. Provider business mailing address

PO BOX 5
TEXARKANA TX
75504-0005
US

V. Phone/Fax

Practice location:
  • Phone: 870-216-1561
  • Fax: 870-216-1570
Mailing address:
  • Phone: 870-216-1561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1525
License Number StateAR

VIII. Authorized Official

Name: MS. W DARLENA BROWN
Title or Position: EXECUTIVE DIRECTOR/COUNSELOR
Credential: ADC
Phone: 870-216-1561