Provider Demographics
NPI:1841388063
Name:BROWN, VIRGINIA A (LCSW)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:A
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 MELLON ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-6148
Mailing Address - Country:US
Mailing Address - Phone:501-416-9351
Mailing Address - Fax:
Practice Address - Street 1:1300 MELLON ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-6148
Practice Address - Country:US
Practice Address - Phone:501-416-9351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1365-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR19403000000OtherQUALCHOICE
AR800011329OtherRAILROAD MEDICARE
ARP00020686OtherRAILROAD MEDICARE
AR126188726Medicaid
ARP00020686OtherRAILROAD MEDICARE
AR126188726Medicaid