Provider Demographics
NPI:1134892599
Name:BROWN, JAMISE VALICE (LPC,CSAC,CSOTP-T,MA)
Entity type:Individual
Prefix:
First Name:JAMISE
Middle Name:VALICE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LPC,CSAC,CSOTP-T,MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 POCOSHOCK PL STE 301
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-6345
Mailing Address - Country:US
Mailing Address - Phone:804-489-3463
Mailing Address - Fax:804-258-4801
Practice Address - Street 1:2500 POCOSHOCK PL STE 302A
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-6345
Practice Address - Country:US
Practice Address - Phone:804-502-2167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704014048101YM0800X
VA0815000343103TC1900X
VA0710103686101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling