Provider Demographics
NPI:1336653500
Name:BROWN, ANITA R (LCSWA)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:R
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3106 CEDARHURST DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-4712
Mailing Address - Country:US
Mailing Address - Phone:704-777-0843
Mailing Address - Fax:
Practice Address - Street 1:3106 CEDARHURST DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-4712
Practice Address - Country:US
Practice Address - Phone:704-777-0843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0119111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical