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General NPI Number Information
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NPI Number | 1023559028
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Entity Type | Individual
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Provider Name | LAVENIA BROWN
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Gender | Female
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Dates
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Enumeration Date | 03/10/2017
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Last Update Date | 03/10/2017
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Provider Practice Location Address
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Address Line | 1466 LINCOLN AVE
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City | SAN RAFAEL
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State | CA
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Zip | 94901-2021
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Country | US
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Telephone | 415-457-3755
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Fax |
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Provider Business Mailing Address
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Address Line | 64 TAHOE CIR
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City | NOVATO
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State | CA
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Zip | 94947-5236
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Country | US
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Telephone | 415-457-3755
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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