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General NPI Number Information
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NPI Number | 1972042802
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Entity Type | Individual
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Provider Name | MICHELLE BROWN BCBA
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Gender | Female
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Dates
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Enumeration Date | 02/12/2017
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 105 GRAND CENTRAL BLVD STE 101
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City | POOLER
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State | GA
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Zip | 31322-4146
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Country | US
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Telephone | 912-388-1035
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Fax | 912-525-0581
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Provider Business Mailing Address
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Address Line | 632 WYNDHAM WAY
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City | POOLER
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State | GA
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Zip | 31322-3623
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Country | US
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Telephone | 561-221-4343
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 12042232
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License Number State | GA
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