Provider Demographics
NPI:1487027918
Name:BROWN, SAMONICA
Entity Type:Individual
Prefix:
First Name:SAMONICA
Middle Name:
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 1:201 HOLIDAY BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-5088
Mailing Address - Country:US
Mailing Address - Phone:985-624-2942
Mailing Address - Fax:985-231-1373
Practice Address - Street 1:201 HOLIDAY BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5088
Practice Address - Country:US
Practice Address - Phone:985-624-2942
Practice Address - Fax:985-231-1373
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5235101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional