Provider Demographics
NPI:1306041991
Name:BROWN, CHARLES H JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:H
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:769 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5936
Mailing Address - Country:US
Mailing Address - Phone:704-333-5997
Mailing Address - Fax:
Practice Address - Street 1:1332 HARDING PL
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2922
Practice Address - Country:US
Practice Address - Phone:704-333-2988
Practice Address - Fax:704-333-3102
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC726103T00000X, 103TC0700X
103TE1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical