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General NPI Number Information
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NPI Number | 1972202513
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Entity Type | Individual
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Provider Name | JESSICA BROWN LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/02/2023
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Last Update Date | 03/02/2023
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Provider Practice Location Address
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Address Line | 5014 MONUMENT AVE
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City | RICHMOND
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State | VA
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Zip | 23230-3620
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Country | US
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Telephone | 804-497-4676
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Fax |
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Provider Business Mailing Address
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Address Line | 12040 KENTON RIDGE RD
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City | ASHLAND
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State | VA
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Zip | 23005-7556
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Country | US
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Telephone | 804-337-0991
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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 | 0904014907
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License Number State | VA
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