Healthcare Provider Details

I. General information

NPI: 1265944565
Provider Name (Legal Business Name): SHEILA JACKSON BROWN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 10/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W BANK ST STE 6
PETERSBURG VA
23803-3279
US

IV. Provider business mailing address

15737 PYPERS POINTE DR
CHESTERFIELD VA
23838-4164
US

V. Phone/Fax

Practice location:
  • Phone: 804-862-8002
  • Fax: 804-862-8023
Mailing address:
  • Phone: 804-862-8002
  • Fax: 804-862-8023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701007188
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: