Provider Demographics
NPI:1972048080
Name:BROWN, JENNA MARJORIE
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:MARJORIE
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 MOUNTAIN PARK DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-9281
Mailing Address - Country:US
Mailing Address - Phone:509-991-8524
Mailing Address - Fax:
Practice Address - Street 1:2030 MOUNTAIN PARK DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28214-9281
Practice Address - Country:US
Practice Address - Phone:509-991-8524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health