Provider Demographics
NPI:1063004133
Name:BROWN, JUANITA (CDCA)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 BUSCH BLVD STE 190
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-2510
Mailing Address - Country:US
Mailing Address - Phone:614-615-0352
Mailing Address - Fax:
Practice Address - Street 1:6161 BUSCH BLVD STE 190
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-2510
Practice Address - Country:US
Practice Address - Phone:614-615-0352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174394101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)