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General NPI Number Information
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NPI Number | 1033364823
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Entity Type | Organization
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Legal Business Name | REBA BROWN INC
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Dates
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Enumeration Date | 11/21/2008
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Last Update Date | 11/21/2008
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Provider Practice Location Address
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Address Line | 114 PLEASANT HOME RD STE A
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City | AUGUSTA
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State | GA
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Zip | 30907-3518
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Country | US
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Telephone | 706-364-7398
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Fax |
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Provider Business Mailing Address
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Address Line | 114 PLEASANT HOME RD STE A
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City | AUGUSTA
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State | GA
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Zip | 30907-3518
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Country | US
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Telephone | 706-364-7398
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | REBA H BROWN
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Credential | LCSW
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Telephone | 706-364-7398
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | CSW000588
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License Number State | GA
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