Healthcare Provider Details

I. General information

NPI: 1992616627
Provider Name (Legal Business Name): EDYTHE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 LAFAYETTE BLVD STE 218B
FREDERICKSBURG VA
22408-4271
US

IV. Provider business mailing address

4414 LAFAYETTE BLVD STE 218B
FREDERICKSBURG VA
22408-4271
US

V. Phone/Fax

Practice location:
  • Phone: 540-845-2318
  • Fax:
Mailing address:
  • Phone: 540-845-2318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704018947
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: