Provider Demographics
NPI:1578636403
Name:BROWN, TERESA SKIPPER (MED)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:SKIPPER
Last Name:BROWN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 PINE DR
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:GA
Mailing Address - Zip Code:31569-4504
Mailing Address - Country:US
Mailing Address - Phone:912-822-9114
Mailing Address - Fax:912-882-9114
Practice Address - Street 1:256 PINE DR
Practice Address - Street 2:
Practice Address - City:WOODBINE
Practice Address - State:GA
Practice Address - Zip Code:31569-4504
Practice Address - Country:US
Practice Address - Phone:912-822-9114
Practice Address - Fax:912-882-9114
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health