Provider Demographics
NPI:1396982880
Name:BROWN, MADONNA (NCC, LPC, CCMHC)
Entity type:Individual
Prefix:MRS
First Name:MADONNA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:NCC, LPC, CCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10494
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27532-0494
Mailing Address - Country:US
Mailing Address - Phone:919-440-6197
Mailing Address - Fax:
Practice Address - Street 1:1503-H WAYNE MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-2231
Practice Address - Country:US
Practice Address - Phone:919-330-4576
Practice Address - Fax:919-581-5017
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7277101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104118Medicaid