Healthcare Provider Details

I. General information

NPI: 1568914604
Provider Name (Legal Business Name): DR. CANDICE NORRIS-BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2016
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 HUNTINGTON PLACE CIR
LITHONIA GA
30058-3036
US

IV. Provider business mailing address

3350 NORTHLAKE PKWY NE STE B-3
ATLANTA GA
30345-2204
US

V. Phone/Fax

Practice location:
  • Phone: 404-202-2061
  • Fax:
Mailing address:
  • Phone: 404-202-2061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberPC0011040
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701005764
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC004442
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC0011040
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: