MEDICARE: EBONY BROWN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor
3	1041S0200X	School Social Worker
4	1041C0700X	Clinical Social Worker	0904013957	VA

General Provider Information

NPI Number	:	1386353191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EBONY BROWN

Provider Business Mailing Address
First Line	:	1320 RICHMOND RD # 1015
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-2831
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1320 RICHMOND RD # 1015
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-2831
Country	:	US
Telephone Number	:	757-509-7236
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2022
Last Update Date	:	11/21/2022

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Directions to “ EBONY BROWN ” Practice Location

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