Provider Demographics
NPI:1245740943
Name:DARNELL BROWN COMMUNITY DEVELOPMENT CORPORATION
Entity Type:Organization
Organization Name:DARNELL BROWN COMMUNITY DEVELOPMENT CORPORATION
Other - Org Name:FROM BONDAGE TO FREEDOM
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:W DARLENA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:ADC
Authorized Official - Phone:870-216-1561
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75504-0005
Mailing Address - Country:US
Mailing Address - Phone:870-216-1561
Mailing Address - Fax:
Practice Address - Street 1:922 GARLAND AVE
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-5055
Practice Address - Country:US
Practice Address - Phone:870-216-1561
Practice Address - Fax:870-216-1570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1525101YA0400X
171M00000X, 177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No177F00000XOther Service ProvidersLodgingGroup - Multi-Specialty