Provider Demographics
NPI:1457698268
Name:BROWN, EBONY
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 W MILLBROOK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4676
Mailing Address - Country:US
Mailing Address - Phone:919-665-4673
Mailing Address - Fax:919-882-8348
Practice Address - Street 1:690 N REILLY RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5724
Practice Address - Country:US
Practice Address - Phone:919-665-4673
Practice Address - Fax:919-882-8348
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0084841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical