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General NPI Number Information
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NPI Number | 1932504917
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Entity Type | Individual
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Provider Name | GENEEN NICHOLE BROWN LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/03/2014
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Last Update Date | 07/27/2021
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Provider Practice Location Address
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Address Line | 127 PETERS ST
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City | LAGRANGE
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State | GA
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Zip | 30240
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Country | US
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Telephone | 917-753-5174
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Fax |
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Provider Business Mailing Address
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Address Line | 137B COMMERCE AVE STE 262
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City | LAGRANGE
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State | GA
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Zip | 30241-2337
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Country | US
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Telephone | 917-753-5174
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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 | 082177-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW005514
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License Number State | GA
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