Healthcare Provider Details

I. General information

NPI: 1669640009
Provider Name (Legal Business Name): SUSAN HAYNES BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 WESLEY DR
CHAPEL HILL NC
27516-1522
US

IV. Provider business mailing address

304 WESLEY DR
CHAPEL HILL NC
27516-1522
US

V. Phone/Fax

Practice location:
  • Phone: 919-932-5441
  • Fax:
Mailing address:
  • Phone: 919-932-5441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC003812
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: