Healthcare Provider Details

I. General information

NPI: 1952344368
Provider Name (Legal Business Name): TED PHILLIP BROWN L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W BANK ST SUITE 5
PETERSBURG VA
23803-3279
US

IV. Provider business mailing address

1701 AIRLEIGH CT
RICHMOND VA
23235-4503
US

V. Phone/Fax

Practice location:
  • Phone: 804-863-1689
  • Fax:
Mailing address:
  • Phone: 804-560-0226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904004493
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: