Provider Demographics
NPI:1568882827
Name:BROWN, KENNETH (LPCA)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7225 MARINERS LANDING DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-7479
Mailing Address - Country:US
Mailing Address - Phone:314-680-1018
Mailing Address - Fax:910-570-8826
Practice Address - Street 1:901 ARSENAL AVENUE
Practice Address - Street 2:SUITE
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305
Practice Address - Country:US
Practice Address - Phone:910-323-3368
Practice Address - Fax:910-486-7000
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10683101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health