Provider Demographics
NPI:1497025167
Name:BROWN, DELLAVE (LCSW-A)
Entity Type:Individual
Prefix:
First Name:DELLAVE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 VEST MILL RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2912
Mailing Address - Country:US
Mailing Address - Phone:336-659-6135
Mailing Address - Fax:336-659-6184
Practice Address - Street 1:3720 VEST MILL RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2912
Practice Address - Country:US
Practice Address - Phone:336-659-6135
Practice Address - Fax:336-659-6184
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0075951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical