Provider Demographics
NPI:1861004996
Name:BROWN, RODERICK EUGENE JR (LCSWA)
Entity Type:Individual
Prefix:MR
First Name:RODERICK
Middle Name:EUGENE
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2904 ARISTOCRAT LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-9527
Mailing Address - Country:US
Mailing Address - Phone:910-723-4980
Mailing Address - Fax:
Practice Address - Street 1:2014 LITHO PL STE 200
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-2518
Practice Address - Country:US
Practice Address - Phone:910-703-8402
Practice Address - Fax:910-703-8674
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0150311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical