Healthcare Provider Details

I. General information

NPI: 1568875912
Provider Name (Legal Business Name): LUIS KENYATTA BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2014
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 WILLOW PASS RD
CONCORD CA
94520-7928
US

IV. Provider business mailing address

2280 DIAMOND BLVD STE 500
CONCORD CA
94520-5719
US

V. Phone/Fax

Practice location:
  • Phone: 925-288-3949
  • Fax:
Mailing address:
  • Phone: 925-812-7680
  • Fax: 925-646-5774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: