Provider Demographics
NPI:1922348713
Name:BROWN, MARY BALL (PMHCNS, BC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:BALL
Last Name:BROWN
Suffix:
Gender:F
Credentials:PMHCNS, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1761 OLD MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-4315
Mailing Address - Country:US
Mailing Address - Phone:703-531-6302
Mailing Address - Fax:
Practice Address - Street 1:1761 OLD MEADOW RD
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-4315
Practice Address - Country:US
Practice Address - Phone:703-531-6302
Practice Address - Fax:703-448-3723
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001108010163WP0809X
VA0015000768364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult