Healthcare Provider Details

I. General information

NPI: 1194366187
Provider Name (Legal Business Name): MRS. SHERRY JEANNINE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2019
Last Update Date: 11/17/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24600 MILLSTREAM DR STE 340
STONE RIDGE VA
20105-5686
US

IV. Provider business mailing address

13955 MANSARDE AVE APT 309
HERNDON VA
20171-6365
US

V. Phone/Fax

Practice location:
  • Phone: 703-327-0335
  • Fax:
Mailing address:
  • Phone: 267-601-1945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: