Healthcare Provider Details

I. General information

NPI: 1063586253
Provider Name (Legal Business Name): WILLIAM WADE BROWN HSP-PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 08/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 MEADOW LN
MORGANTON NC
28655-9671
US

IV. Provider business mailing address

1435 MEADOW LN
MORGANTON NC
28655-9671
US

V. Phone/Fax

Practice location:
  • Phone: 828-443-9486
  • Fax: 828-433-1793
Mailing address:
  • Phone: 828-443-9486
  • Fax: 828-433-1793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number541
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number541
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: