Healthcare Provider Details

I. General information

NPI: 1518046127
Provider Name (Legal Business Name): MR. MATTHEW WILSON BROWN I
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 BRIGHTON HILL RD
COLUMBIA SC
29223-7987
US

IV. Provider business mailing address

90 BRIGHTON HILL RD
COLUMBIA SC
29223-7987
US

V. Phone/Fax

Practice location:
  • Phone: 803-741-1271
  • Fax: 803-741-7429
Mailing address:
  • Phone: 803-741-1271
  • Fax: 803-741-7429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: