Provider Demographics
NPI:1699012393
Name:BROWN, ANITA BLANDENA (LPC)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:BLANDENA
Last Name:BROWN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MATHESON ST
Mailing Address - Street 2:
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512-4034
Mailing Address - Country:US
Mailing Address - Phone:843-479-5701
Mailing Address - Fax:843-479-9680
Practice Address - Street 1:100 MATHESON ST
Practice Address - Street 2:
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512-4034
Practice Address - Country:US
Practice Address - Phone:843-479-5701
Practice Address - Fax:843-479-9680
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2607101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional