Provider Demographics
NPI:1760726228
Name:BROWN, JEWRINE VONCILE (LCMHC)
Entity Type:Individual
Prefix:
First Name:JEWRINE
Middle Name:VONCILE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:JEWRINE
Other - Middle Name:VONCILE
Other - Last Name:HAROLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCMHC
Mailing Address - Street 1:3357 VARDAMAN AVE
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-9696
Mailing Address - Country:US
Mailing Address - Phone:910-574-0625
Mailing Address - Fax:
Practice Address - Street 1:2606 RAEFORD RD STE 31
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5476
Practice Address - Country:US
Practice Address - Phone:910-574-3487
Practice Address - Fax:910-653-1521
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-21
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2784-A101YA0400X
NC10242101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)