Healthcare Provider Details

I. General information

NPI: 1770289746
Provider Name (Legal Business Name): JAMELA BROWN BA, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 WASHINGTON ST W
CHARLESTON WV
25302-1333
US

IV. Provider business mailing address

4808 CHURCH DR
CHARLESTON WV
25306-6348
US

V. Phone/Fax

Practice location:
  • Phone: 304-202-1699
  • Fax:
Mailing address:
  • Phone: 304-539-3523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberAP00944333
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: