Provider Demographics
NPI:1649210923
Name:BROWN, ANITA BURNETT (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:BURNETT
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18 PINE LAKE CT
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-1200
Mailing Address - Country:US
Mailing Address - Phone:757-850-4482
Mailing Address - Fax:757-850-4482
Practice Address - Street 1:515 STERNBERG AVE
Practice Address - Street 2:CMHS MCAHC USAMEDDAC
Practice Address - City:FORT EUSTIS
Practice Address - State:VA
Practice Address - Zip Code:23604-1526
Practice Address - Country:US
Practice Address - Phone:757-314-7558
Practice Address - Fax:757-314-7979
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003311103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical