MEDICARE: ELIZABETH CORINNE BROWN CDCA

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	171M00000X	Case Manager/Care Coordinator
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDCA.187939	OH

General Provider Information

NPI Number	:	1699458430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH CORINNE BROWN CDCA

Provider Business Mailing Address
First Line	:	6400 E BROAD ST STE 400
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-2979
Country	:	US
Telephone Number	:	614-655-3345
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 WAYNE AVE BLDG 61
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45420-1834
Country	:	US
Telephone Number	:	937-641-8558
Fax Number	:

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

Provider Enumeration Date	:	08/09/2023
Last Update Date	:	08/19/2024

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