Provider Demographics
NPI:1184181695
Name:BROWN, HERBERT CLIFFORD (LCSWA)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:CLIFFORD
Last Name:BROWN
Suffix:
Gender:M
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 WYNMORE RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-4095
Mailing Address - Country:US
Mailing Address - Phone:984-239-7165
Mailing Address - Fax:
Practice Address - Street 1:210 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-5325
Practice Address - Country:US
Practice Address - Phone:336-330-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-21
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0131291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical