Provider Demographics
NPI:1821508698
Name:BROWN, CALIE (LAC, LPC, LPCC)
Entity Type:Individual
Prefix:
First Name:CALIE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:LAC, LPC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 BURNT BOAT DR
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:107 W MAIN AVE STE 350
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-3893
Practice Address - Country:US
Practice Address - Phone:800-627-8220
Practice Address - Fax:651-925-0057
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1804101YA0400X
ND984-12-01-18A101YP2500X
ND984-12-01-18-411101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty