Provider Demographics
NPI:1003482639
Name:BROWN, CHRISTA DEVAUGHN (LICSW)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:DEVAUGHN
Last Name:BROWN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:CHRISTA
Other - Middle Name:
Other - Last Name:DEVAUGHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:894 77TH WAY S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35206-4905
Mailing Address - Country:US
Mailing Address - Phone:205-305-8659
Mailing Address - Fax:
Practice Address - Street 1:3220 5TH AVE S STE 100
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35222-2309
Practice Address - Country:US
Practice Address - Phone:205-877-8677
Practice Address - Fax:205-877-8675
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4763C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical