Provider Demographics
NPI:1710632963
Name:BROWN, TYCHELLE MARTINE (LMHP-R)
Entity Type:Individual
Prefix:
First Name:TYCHELLE
Middle Name:MARTINE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMHP-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DELANO ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23234-1533
Mailing Address - Country:US
Mailing Address - Phone:804-625-1094
Mailing Address - Fax:
Practice Address - Street 1:3400 DELANO ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23234-1533
Practice Address - Country:US
Practice Address - Phone:804-625-1094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
VA0704013685101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1982804308Medicaid