Healthcare Provider Details

I. General information

NPI: 1114837275
Provider Name (Legal Business Name): ISSIS NECOLE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

4225 PORTSMOUTH BLVD STE B
CHESAPEAKE VA
23321-2154
US

IV. Provider business mailing address

907 WALNUT ST
FRANKLIN VA
23851-2044
US

V. Phone/Fax

Practice location:
  • Phone: 757-335-4380
  • Fax:
Mailing address:
  • Phone: 757-323-8825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: