Provider Demographics
NPI:1174860324
Name:BROWN, CARISSA RENEE (MA, LCMHCS)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:RENEE
Last Name:BROWN
Suffix:
Gender:F
Credentials:MA, LCMHCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 EXECUTIVE PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1833
Mailing Address - Country:US
Mailing Address - Phone:704-939-1100
Mailing Address - Fax:704-939-1173
Practice Address - Street 1:1105 E CARDINAL ST
Practice Address - Street 2:
Practice Address - City:SILER CITY
Practice Address - State:NC
Practice Address - Zip Code:27344-3300
Practice Address - Country:US
Practice Address - Phone:919-663-2955
Practice Address - Fax:919-799-7713
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9147101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1174860324OtherHUMANA
NC19H2HOtherBCBS
NC601121-450OtherMAGELLAN
NC1174860324Medicaid