Healthcare Provider Details

I. General information

NPI: 1184609711
Provider Name (Legal Business Name): MARION J BROWN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 10/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5318 PATTERSON AVE SUITE C
RICHMOND VA
23226-2044
US

IV. Provider business mailing address

5318 PATTERSON AVE SUITE C
RICHMOND VA
23226-2044
US

V. Phone/Fax

Practice location:
  • Phone: 804-257-9311
  • Fax: 804-285-0010
Mailing address:
  • Phone: 804-257-9311
  • Fax: 804-285-0010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904001039
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: