Healthcare Provider Details

I. General information

NPI: 1306041991
Provider Name (Legal Business Name): CHARLES H. BROWN JR. PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1332 HARDING PL
CHARLOTTE NC
28204-2922
US

IV. Provider business mailing address

769 MAGNOLIA AVE
CHARLOTTE NC
28203-5936
US

V. Phone/Fax

Practice location:
  • Phone: 704-333-2988
  • Fax: 704-333-3102
Mailing address:
  • Phone: 704-333-5997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number726
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number726
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: