Healthcare Provider Details

I. General information

NPI: 1730721036
Provider Name (Legal Business Name): BROWN PROFESSIONAL COUNSELING & CONSULTATION SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2019
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 RUSSELL PKWY STE 2
WARNER ROBINS GA
31088-5586
US

IV. Provider business mailing address

1105 RUSSELL PKWY STE 2
WARNER ROBINS GA
31088-5586
US

V. Phone/Fax

Practice location:
  • Phone: 478-227-0954
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIERRA BROWN
Title or Position: CEO
Credential: MS,LPC
Phone: 478-227-0954