Provider Demographics
NPI:1013350867
Name:BROWN, CHARLES NICHOLAS (LPCC)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:NICHOLAS
Last Name:BROWN
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPCC
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-344-5555
Mailing Address - Fax:859-344-5552
Practice Address - Street 1:200 W 3RD ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:KY
Practice Address - Zip Code:41071-1814
Practice Address - Country:US
Practice Address - Phone:859-301-5901
Practice Address - Fax:859-301-5940
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYLPCPCC00218319101YM0800X, 101YP2500X
KY1591101YP2500X
KY164140101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100333760Medicaid
KY610661458OtherTAX ID
KY611300608OtherTAX IDENTIFICATION NUMBER
OH0155170Medicaid