Provider Demographics
NPI:1154943389
Name:BROWN, CHARNELL C (MAJOR ON MENTHAL HEA)
Entity type:Individual
Prefix:
First Name:CHARNELL
Middle Name:C
Last Name:BROWN
Suffix:
Gender:F
Credentials:MAJOR ON MENTHAL HEA
Other - Prefix:
Other - First Name:CHARNELL
Other - Middle Name:C
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CHARNELL C BROWN
Mailing Address - Street 1:301 N MAIN ST STE 1202
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-3819
Mailing Address - Country:US
Mailing Address - Phone:336-721-4262
Mailing Address - Fax:336-232-1630
Practice Address - Street 1:127 TUNSTALL RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4236
Practice Address - Country:US
Practice Address - Phone:434-835-2983
Practice Address - Fax:434-228-4786
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704010586101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health