Provider Demographics
NPI:1619176849
Name:BROWN, EVELYN CARTER (LPC)
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:CARTER
Last Name:BROWN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:
Other - Last Name:BROWN-VINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:1316 MARTINIQUE DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-2620
Mailing Address - Country:US
Mailing Address - Phone:706-733-1640
Mailing Address - Fax:706-733-1640
Practice Address - Street 1:1227 AUGUSTA WEST PKWY
Practice Address - Street 2:SUITE 3
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6670
Practice Address - Country:US
Practice Address - Phone:706-733-1640
Practice Address - Fax:706-733-1640
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC000966101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional