Provider Demographics
NPI:1013672997
Name:BROWN, ANNTANA MICHELLE (LGPC)
Entity Type:Individual
Prefix:
First Name:ANNTANA
Middle Name:MICHELLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19913 ASHFIELD CT
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-6712
Mailing Address - Country:US
Mailing Address - Phone:240-707-8361
Mailing Address - Fax:
Practice Address - Street 1:19913 ASHFIELD CT
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6712
Practice Address - Country:US
Practice Address - Phone:240-707-8361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-04
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC12350101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional