Healthcare Provider Details

I. General information

NPI: 1003695735
Provider Name (Legal Business Name): CHERYL MARIE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2023
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 EDGEWOOD TERRACE DR
JACKSON MS
39206-6217
US

IV. Provider business mailing address

1905 MISSION 66
VICKSBURG MS
39180-3711
US

V. Phone/Fax

Practice location:
  • Phone: 601-487-6344
  • Fax: 601-398-0289
Mailing address:
  • Phone: 601-738-5820
  • Fax: 601-738-5083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: