Healthcare Provider Details

I. General information

NPI: 1295514727
Provider Name (Legal Business Name): EBONY KATRESE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 FAIR OAKS BLVD
CARMICHAEL CA
95608-2502
US

IV. Provider business mailing address

68 NEDRA CT APT 2
SACRAMENTO CA
95822-5633
US

V. Phone/Fax

Practice location:
  • Phone: 191-694-4392
  • Fax:
Mailing address:
  • Phone: 916-879-2325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: