MEDICARE: MS. PHAEDRA BROWN M.ED., LPC

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	101YP2500X	Professional Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508248907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PHAEDRA BROWN M.ED., LPC

Provider Business Mailing Address
First Line	:	1800 PHOENIX BLVD STE 128
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-5555
Country	:	US
Telephone Number	:	404-947-8951
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 PHOENIX BLVD STE 128
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-5555
Country	:	US
Telephone Number	:	404-947-8951
Fax Number	:	404-586-0102

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

Provider Enumeration Date	:	06/22/2015
Last Update Date	:	08/11/2022

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