=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922694116
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KOLA LANETTE BROWN LAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2020
-----------------------------------------------------
Last Update Date | 05/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 205 W BOND AVE
-----------------------------------------------------
City | WEST MEMPHIS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72301-3907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-400-8079
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1523
-----------------------------------------------------
City | NORTH LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72115-1523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-303-6278
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225C00000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | A1803023
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------