Provider Demographics
NPI:1518239672
Name:BROWN, SHANTA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SHANTA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-9540
Mailing Address - Country:US
Mailing Address - Phone:336-223-4232
Mailing Address - Fax:
Practice Address - Street 1:701 W MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NC
Practice Address - Zip Code:27282-9540
Practice Address - Country:US
Practice Address - Phone:336-223-4232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-06
Last Update Date:2019-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9014101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health