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General NPI Number Information
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NPI Number | 1629568142
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Entity Type | Individual
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Provider Name | MR. CHARLES BROWN
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Gender | Male
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Dates
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Enumeration Date | 05/10/2018
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Last Update Date | 05/10/2018
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Provider Practice Location Address
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Address Line | 2145 METROCENTER BLVD STE 350
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City | ORLANDO
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State | FL
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Zip | 32835-7642
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Country | US
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Telephone | 407-218-4800
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Fax |
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Provider Business Mailing Address
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Address Line | 8820 SOUTHERN BREEZE DR
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City | ORLANDO
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State | FL
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Zip | 32836-5011
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Country | US
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Telephone | 407-810-7143
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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 | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 120417
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State | FL
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