Healthcare Provider Details

I. General information

NPI: 1104739283
Provider Name (Legal Business Name): LYNETTE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1782 GIBSON ST
FAYETTEVILLE NC
28301-4179
US

IV. Provider business mailing address

1782 GIBSON ST
FAYETTEVILLE NC
28301-4179
US

V. Phone/Fax

Practice location:
  • Phone: 910-261-0864
  • Fax:
Mailing address:
  • Phone: 910-261-0864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1519558
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: