Healthcare Provider Details

I. General information

NPI: 1912421371
Provider Name (Legal Business Name): SAMANTHA RAE BROWN LPCCS, LCDC III, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2017
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6343 LINCOLN AVE APT O2
BUENA PARK CA
90620-3693
US

IV. Provider business mailing address

6343 LINCOLN AVE APT O2
BUENA PARK CA
90620-3693
US

V. Phone/Fax

Practice location:
  • Phone: 216-307-3919
  • Fax:
Mailing address:
  • Phone: 216-307-3919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2202719
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701013417
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number18302
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: