Provider Demographics
NPI:1417251000
Name:BROWN, NANCY MAY (LCSW, CSOTP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:MAY
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCSW, CSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 DEVILS REACH RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-2806
Mailing Address - Country:US
Mailing Address - Phone:703-492-2994
Mailing Address - Fax:703-490-5505
Practice Address - Street 1:1308 DEVILS REACH RD
Practice Address - Street 2:SUITE 300
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2806
Practice Address - Country:US
Practice Address - Phone:703-492-2994
Practice Address - Fax:703-490-5505
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0812000404101YM0800X
VA09040022741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health