Healthcare Provider Details

I. General information

NPI: 1144948274
Provider Name (Legal Business Name): CAMERON DION BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1467 S 9TH ST
LOUISVILLE KY
40208-2254
US

IV. Provider business mailing address

1705 CRYSTAL SPRINGS AVE
OSHKOSH WI
54902-6122
US

V. Phone/Fax

Practice location:
  • Phone: 502-498-0908
  • Fax:
Mailing address:
  • Phone: 920-252-9024
  • Fax:

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 Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: