Healthcare Provider Details

I. General information

NPI: 1023504933
Provider Name (Legal Business Name): JUANITA BROWN, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2018
Last Update Date: 07/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 4TH ST SW
HICKORY NC
28602-2819
US

IV. Provider business mailing address

306 4TH ST SW
HICKORY NC
28602-2819
US

V. Phone/Fax

Practice location:
  • Phone: 828-201-0620
  • Fax:
Mailing address:
  • Phone: 828-201-0620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TRICIA CHAPMAN
Title or Position: ADMIN
Credential:
Phone: 828-391-0611