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General NPI Number Information
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NPI Number | 1649156555
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Entity Type | Individual
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Provider Name | DAVONNA MARIE NICHOLS-BROWN
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Gender | Female
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Dates
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Enumeration Date | 08/14/2025
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Last Update Date | 01/27/2026
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Provider Practice Location Address
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Address Line | 126 LITHIA PINECREST RD STE 102
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City | BRANDON
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State | FL
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Zip | 33511-5347
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Country | US
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Telephone | 863-535-6414
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Fax |
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Provider Business Mailing Address
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Address Line | 5235 ARIVA DR APT 204
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City | LAKELAND
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State | FL
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Zip | 33812-4445
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Country | US
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Telephone |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW25253
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License Number State | FL
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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 | SW25253
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License Number State | FL
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