Provider Demographics
NPI:1790201325
Name:BROWN, ANTHONY ALLEN JR (BS, LCDCIII)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:ALLEN
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:BS, LCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5493 FLOTRON DR
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-3828
Mailing Address - Country:US
Mailing Address - Phone:937-529-1169
Mailing Address - Fax:
Practice Address - Street 1:6929 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-2563
Practice Address - Country:US
Practice Address - Phone:937-259-8805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH111115101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty