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General NPI Number Information
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NPI Number | 1285648170
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Entity Type | Individual
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Provider Name | CHARLES JACOB BROWN PH.D
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Gender | Male
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 10/25/2022
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Provider Practice Location Address
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Address Line | 726 EAST BLVD
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City | CHARLOTTE
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State | NC
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Zip | 28203-5114
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Country | US
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Telephone | 704-376-8494
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Fax |
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Provider Business Mailing Address
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Address Line | 726 EAST BLVD
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City | CHARLOTTE
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State | NC
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Zip | 28203-5114
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Country | US
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Telephone | 704-376-8494
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 1981
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PP1981
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License Number State | NC
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