Provider Demographics
NPI:1457737215
Name:MORGAN BROWN, JUSTINE (LAADC)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:MORGAN BROWN
Suffix:
Gender:F
Credentials:LAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 AVENIDA GRANADA
Mailing Address - Street 2:#46
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-5287
Mailing Address - Country:US
Mailing Address - Phone:949-456-3732
Mailing Address - Fax:
Practice Address - Street 1:3340 KEMPER ST STE 105
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4907
Practice Address - Country:US
Practice Address - Phone:619-523-8121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-04
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALR01650715101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA373781Medicaid