Provider Demographics
NPI:1467106310
Name:BROWN, BERTHINIA ALICIA (LCDC)
Entity Type:Individual
Prefix:
First Name:BERTHINIA
Middle Name:ALICIA
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9714 S GESSNER RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071-1004
Mailing Address - Country:US
Mailing Address - Phone:346-471-3791
Mailing Address - Fax:
Practice Address - Street 1:9714 S GESSNER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77071-1004
Practice Address - Country:US
Practice Address - Phone:346-471-3791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11761101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)