Provider Demographics
NPI:1376888917
Name:BROWN, BROUILLARD VIRGINIA
Entity Type:Individual
Prefix:
First Name:BROUILLARD
Middle Name:VIRGINIA
Last Name:BROWN
Suffix:
Gender:F
Credentials:
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 898
Mailing Address - Street 2:707 N WASHINGTON STREET
Mailing Address - City:QUITMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31643-0898
Mailing Address - Country:US
Mailing Address - Phone:229-548-3000
Mailing Address - Fax:
Practice Address - Street 1:707 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:GA
Practice Address - Zip Code:31643-1657
Practice Address - Country:US
Practice Address - Phone:229-548-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-08
Last Update Date:2012-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health