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General NPI Number Information
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NPI Number | 1235601337
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Entity Type | Individual
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Provider Name | JERNAE DICKENS-BROWN
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Gender | Female
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Dates
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Enumeration Date | 12/30/2018
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Last Update Date | 11/12/2022
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Provider Practice Location Address
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Address Line | 1050 30TH ST NW # 107
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City | WASHINGTON
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State | DC
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Zip | 20007-3822
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Country | US
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Telephone | 301-640-0300
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Fax |
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Provider Business Mailing Address
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Address Line | 3210 WINTERBOURNE DR
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City | UPPER MARLBORO
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State | MD
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Zip | 20774-9084
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Country | US
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Telephone | 302-640-0300
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PRC200001390
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | PRC200001390
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License Number State | DC
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