Healthcare Provider Details

I. General information

NPI: 1487027918
Provider Name (Legal Business Name): SAMONICA BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2015
Last Update Date: 11/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 HOLIDAY BLVD SUITE 120
COVINGTON LA
70433-5088
US

IV. Provider business mailing address

201 HOLIDAY BLVD SUITE 120
COVINGTON LA
70433-5088
US

V. Phone/Fax

Practice location:
  • Phone: 985-624-2942
  • Fax: 985-231-1373
Mailing address:
  • Phone: 985-624-2942
  • Fax: 985-231-1373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5235
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: