Healthcare Provider Details

I. General information

NPI: 1609485515
Provider Name (Legal Business Name): CHARLEEN BROWN SPROLES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 KATHERINE DR STE B
FLOWOOD MS
39232-9024
US

IV. Provider business mailing address

111 LAWRENCE DR
BRANDON MS
39047-4619
US

V. Phone/Fax

Practice location:
  • Phone: 601-941-7002
  • Fax:
Mailing address:
  • Phone: 601-941-7002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2601
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2601
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: