Provider Demographics
NPI:1619699709
Name:BROWN, ANNA NICOLE (BSW)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:NICOLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 JEBS CT NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-2881
Mailing Address - Country:US
Mailing Address - Phone:706-853-5149
Mailing Address - Fax:
Practice Address - Street 1:2025 JEBS CT NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-2881
Practice Address - Country:US
Practice Address - Phone:706-853-5149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000000000Medicaid
GA000000000OtherSUBSTANCE ABUSE