Provider Demographics
NPI:1306837547
Name:BROWN, MARIE HARRIS (EDD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:HARRIS
Last Name:BROWN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 848
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-0848
Mailing Address - Country:US
Mailing Address - Phone:804-937-0628
Mailing Address - Fax:
Practice Address - Street 1:13801 VILLAGE MILL DR
Practice Address - Street 2:STE 105
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-4382
Practice Address - Country:US
Practice Address - Phone:804-937-0628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701000703101YP2500X
VA0717000916106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist