Provider Demographics
NPI:1780865535
Name:BROWN, OLYMPHIA HAIRSTON (MA/EDS LPC)
Entity Type:Individual
Prefix:MS
First Name:OLYMPHIA
Middle Name:HAIRSTON
Last Name:BROWN
Suffix:
Gender:F
Credentials:MA/EDS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2721 REYNOLDS PARK RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-1548
Mailing Address - Country:US
Mailing Address - Phone:336-749-0778
Mailing Address - Fax:
Practice Address - Street 1:2721 REYNOLDS PARK RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-1548
Practice Address - Country:US
Practice Address - Phone:336-749-0778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6759101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional