Healthcare Provider Details

I. General information

NPI: 1629940218
Provider Name (Legal Business Name): SAVANNAH KATHLEEN BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 SHUCKIN ST
HAMPSTEAD NC
28443-8729
US

IV. Provider business mailing address

732 BONHAM AVE
WILMINGTON NC
28403-2717
US

V. Phone/Fax

Practice location:
  • Phone: 910-599-2230
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-4706889
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: