Provider Demographics
NPI:1467120618
Name:BROWN, DERDINE NOEL (LMHC)
Entity Type:Individual
Prefix:
First Name:DERDINE
Middle Name:NOEL
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 FELLOWSHIP DR
Mailing Address - Street 2:
Mailing Address - City:FERN PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32730-2783
Mailing Address - Country:US
Mailing Address - Phone:407-222-9286
Mailing Address - Fax:
Practice Address - Street 1:603 FELLOWSHIP DR
Practice Address - Street 2:
Practice Address - City:FERN PARK
Practice Address - State:FL
Practice Address - Zip Code:32730-2783
Practice Address - Country:US
Practice Address - Phone:407-222-9286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13710101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty